Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Use of insecticide treated net and malaria preventive education: effect on malaria parasitemia among people living with AIDS in Nigeria, a cross-sectional study

Use of insecticide treated net and malaria preventive education: effect on malaria parasitemia... Background: Malaria and HIV are major causes of morbidity and mortality in sub-Saharan Africa with both diseases highly endemic in Nigeria. This study was conducted to assess the effect of long lasting insecticide treated net (ITN) use and malaria preventive education on burden of malaria parasite among people living with AIDS (PLWHA) at Osogbo southwestern Nigeria. Method: A descriptive cross-sectional study of newly recruited consenting PLWHA that were screened consecutively for malaria, those positive were treated with artemisinin combination therapy. All PLWHA were educated about malaria infection, given ITN and followed up monthly for three months when they were rescreened for malaria infection. Data collected was analyzed using descriptive and inferential statistics. Result: A total of 392 (92%) PLWHA completed the study. Mean age of the respondents was 33 ± 11.6 years. They were 120 (31%) males and 272 (69%) females. Majority (80%) were married, over 33% completed secondary education while 21% had tertiary education. Most were traders (40%) and artisans (25%). About 60% had Plasmodium falciparum malaria parasitemia at baseline which drastically reduced to 5% at three months with ITN use and malaria prevention education. Conclusion: Malaria is a major preventable condition among PLWHA. Preventive education and ITN use reduced malaria parasite burden among this population. Keywords: Malaria, PLWHA, ITN use, Preventive education Background and Plasmodium malariae [4]. Of these four species of Malaria and HIV/AIDS are leading causes of morbidity and plasmodium, Plasmodium falciparum causes the most mortality in sub-Saharan Africa [1]. Both diseases are highly severe malaria illness and death throughout the world. Plas- endemic in Nigeria [2]. Malaria is the most common life modium falciparum is known to be the most devastating in threatening infection with one million deaths per year, Nigeria [2]. Malaria is transmitted through the bite of an 300–500 million infections per year, about 90% of the death infected female anopheles mosquito [4]. occurring in sub-Saharan Africa [3]. Most victims were Nigeria accounts for a quarter of all malaria cases in the children less than 5 years of age and pregnant women [3]. World Health Organization African Region [2]. It is en- Human malaria is a parasitic infection caused by Plasmo- demic throughout the country with more than 90% of the dium falciparum, Plasmodium vivax, Plasmodium ovale total population at risk of stable endemic malaria. At least 50% of the population suffers from at least one episode of malaria each year [4]. Transmission in the south occurs * Correspondence: sanuolowookere@yahoo.com Department of Community Health, College of Health Sciences, Obafemi all-year round, and is more seasonal in the north [4]. Al- Awolowo University, Ile-Ife, Osun State, Nigeria most all cases are caused by P. falciparum but most are Full list of author information is available at the end of the article © 2013 Olowookere et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 2 of 6 http://www.apfmj.com/content/12/1/2 unconfirmed [4]. There is no evidence of a systematic de- monthly while very ill patients were admitted into the cline in malaria burden; the upward trend in numbers of hospital medical wards. cases and deaths is probably due to improvements in reporting [4]. Study design HIV infection increases the risk and severity of malaria This is a descriptive cross-sectional study from June to [3]. The population-level impact depends on HIV preva- December 2010. The study population included new lence, the age distribution of both infections which for PLWHA recruited consecutively by trained research assis- malaria is determined by the transmission intensity, and tants after they have consented to participate following their geographic overlap [5]. Local distributions of CD4 through explanation of the study by the researchers to cell counts and clinical stages of HIV-infected patients them and/or their family caregivers (where respondent are also important because the effects of HIV multiply was less than 18 years). The required sample size of 334 with increasing immunosuppression [3]. Studies on was calculated using an appropriate statistical formula for adults in areas of high malaria transmission showed that estimating the minimum sample size in descriptive health 2 2 HIV-1 infection increased case fatality among hospital- studies [n = Z pq/d ] [7] and finding from a previous study ized persons with severe malaria by 1.6- to 2.5- fold, [6] where 32% of PLWHA studied had malaria. The mini- while the incidence of severe malaria, a precursor of fatal mum sample size was increased by 10% to take care of in- episodes, increased by 2.7-fold. HIV-1 increases malaria complete/non response and refusals. The informed deaths by increasing the proportion of severe cases, case consent form and a pretested questionnaire that included fatality among them, and the failure rate of antimalarials information on biodata, awareness of malaria prevention, treatment. HIV-1 increased malaria incidence by 0.20% and previous ITN use were administered to the research to 28% across countries. HIV-1 increased malaria deaths participants and their family caregivers by the researchers by 0.65% to 114% across countries [5]. In HIV-infected at beginning of the study. These consenting PLWHA had adults, pregnant women, and children, malaria is among their blood film screened consecutively for malaria para- the simplest infections to prevent and treat [6]. site at the beginning of the study. The respondents that The malaria preventive health behaviour had been were malaria parasite positive were treated free with arte- found to be generally poor across Nigeria with less than misinin combination therapy regimen while all clients’ and 10% respondents using long lasting insecticide treated their family caregivers’ undergone education about malaria net (ITN) [2]. Malaria is a major public health problem and HIV infection. They were then given ITN free which in Nigeria, accounting for about 60% of all outpatient at- they were encouraged to sleep under every night. They tendances and 30% of all hospital admissions [4]. It is es- were followed up monthly for three months when they had timated that malaria is responsible for nearly 110 million their blood film rescreened for malaria parasite. The study clinical cases and an estimated 300,000 deaths per year, participants were also interviewed with these question- including up to 11% of maternal mortality [2]. naires during their monthly visits to the clinic. Also these This study was conducted to assess the effect of ITN use respondents were visited at home by the antiretroviral clinic and malaria preventive education on burden of malaria home visit team to ensure adherence to antiretroviral drug parasitemia among people living with AIDS (PLWHA) at therapy, cotrimoxazole, preventive education and ITN use. Osogbo southwestern Nigeria. Ethical consideration included taking informed con- sent from respondents and their family caregiver, using serial numbers and not names to maintain confidential- Methodology ity of information obtained. Permission to conduct the Study site study was granted by the Osun State Hospital Ethics and The antiretroviral (ARV) clinic located at State hospital Research Committee. Data collected were kept in a pass- Osogbo, Osun State, southwest Nigeria was established word computer. February 2009. The hospital is a free treatment General Data obtained was entered into SPSS version 16. Sum- hospital attending to about 10,000 patients weekly. The mary statistics using mean, median, standard deviation, ARV Clinic offers comprehensive HIV/AIDS care for all range for continuous variables and frequency/percent- the 31 local government health facilities in Osun State ages for categorical variables were generated. Chi square and beyond. This clinic is supported by the Osun State statistics was used to test association between categorical Ministry of Health in collaboration with Global HIV/ variables with p value less than 0.05 taken as significant. AIDS Initiative in Nigeria. PLWHA receive care and support including antiretroviral therapy at the clinic Results which opens every Mondays and Wednesdays from A total of 392 PLWHA out of 425 completed the study 8 am to 4 pm. It attends to 100–140 PLWHA weekly. (92%). Thirty-three respondents opted out of the study Patients on care were usually routinely followed up for personal reasons such as unscheduled traveling. No Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 3 of 6 http://www.apfmj.com/content/12/1/2 respondent died or were lost to follow up during Table 3 showed the respondent’s sociodemographic the study period. Mean age of the respondents was characteristics and malaria positivity at baseline and three 33 years ± 11.6 years (Range = 13-60 years). months follow up. Majority (68%) of the respondents in Table 1 reported the sociodemographic characteristics the formal sector was malaria parasite positive at baseline of respondents. They were 120 (31%) males and 272 but all were malaria parasite negative by third month. (69%) females. Majority were married (80%), 33% com- Over 45% of respondents who were not using ITN had pleted secondary education while 21% had tertiary edu- malaria parasitemia at third month follow up. cation. Most were traders (40%) and artisans (25%). At Common reasons for inconsistent or non use of ITN in- baseline all respondents saw malaria as a threat to good cluded night duty (39%), reaction to the permethrin em- health while 42% were aware that malaria could be bedded in the net (27%) while some respondents never prevented but none sleep under ITN at home. Reasons liked sleeping under ITN (23%). for non use of ITN were non availability (54%), exorbi- tant price (48%), and ignorance (22%). Only 15% used Discussion insecticide spray or coil which they said was inadequate This study assessed the effect of ITN use and malaria pre- as they still get malaria despite constant use. ventiveeducationon burdenof malaria parasitemia among Table 2 reported the pattern of malaria parasitemia people living with AIDS. It reported that preventive educa- and ITN use among the study participants. About 60% tion and ITN use reduced malaria parasitemia over a period had Plasmodium falciparum malaria parasitemia at base- of three months. The high malaria burden at baseline re- line which drastically reduced to 5% at three months duced remarkably by three months. Previous studies had with ITN use and malaria prevention education. Figure 1 shown this among pregnant women and children [2,4]. showed that PLWHA using ITN had no malaria parasit- Majority of the study population had malaria at base- emia at three months. line. This finding is expected as the study area is an area of intense year round malaria transmission. Goselle et al. Table 1 Sociodemographic characteristics of PLWHA in 2009 in a study on malaria infection among PLWHA attending State hospital, Osogbo in Jos, Nigeria reported 32% while Saracino et al. in Sociodemographic characteristics Frequency (N = 392) % 2012 reported 26% in Beira, Mozambique [6,8]. However Age group (years) a much higher burden was reported in the present study 13–18 30 7.7 because most PLWHA studied had no malaria prevent- 19–29 92 23.5 ive education and no access to ITN at baseline. Studies had shown that malaria if not treated and prevented will 30–39 166 42.3 further reduced the quality of life of these immunocom- ≥40 104 26.5 promised population [3,5,6]. Sex This study reported that ITN use protects against mal- Male 120 30.6 aria among the participants. This entails that malaria Female 272 69.4 preventive education and ITN should be routinely given Education to PLWHA to prevent malaria among them, thereby im- proving their quality of life. None 90 23.0 Primary 88 22.4 Table 2 Pattern of malaria parasitemia and ITN use Secondary 130 33.2 among PLWHA at state hospital, Osogbo, Nigeria Tertiary 84 21.4 Malaria parasite result/ITN use Frequency % Marital status Result at baseline Single 64 16.3 Positive 234 59.7 Married 314 80.1 Negative 158 40.3 Divorced/widowed 14 3.6 Result at three month Occupation Positive 20 5.1 Trading 158 40.3 Negative 372 94.9 Civil servant 56 14.3 ITN given at baseline Artisan 98 25.0 Yes 392 100 Police 18 4.6 ITN use at 3 months Clergy 6 1.5 Yes 348 88.8 Unemployed 56 14.3 No 44 11.2 Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 4 of 6 http://www.apfmj.com/content/12/1/2 PLWHA N=392 Malaria Malaria (-), (+), N=234 N=158 ITN use (+), ITN use (+), ITN use (-), ITN use (-), N=137 N=211 N=21 N=23 Malaria Malaria (-), Malaria Malaria Malaria (-), Malaria Malaria (-), Malaria (+), N=0 (-), (+), N=9 N=12 N=211 (+), N=12 (+), N=0 N=137 N=11 Figure 1 Flowchart of ITN use and malaria parasitemia among PLWHA. Most respondents gave financial constraints and non This study further showed that consenting PLWHA availability as their reason for non use of ITN at baseline. should be routinely visited at home to observe the con- Various studies on challenges to ITN use in this environ- ditions they lived. This will improve relationship be- ment had reported this finding. For example, Olajide et al. tween these PLWHA and the healthcare team. Studies in a study on challenges with ITN use among pregnant had showed that the living conditions of patients affect women reported that pregnant women did not sleep their health and that improving these living conditions under ITN because of non availability (53%) and cost will improve their quality of life [4,10]. (24%) [9]. This implied that ITN must be made available This study also reported that the respondents working and affordable or free to all PLWHA to reduce malaria in the formal sector with high parasitemia at baseline had burden among them. no malaria parasitemia after three months of continuous Table 3 Respondent’s sociodemographic characteristics and malaria positivity at baseline and three months follow up Characteristics Malaria parasite (baseline) p value Malaria parasite (3rd month) p value Positive (%) Negative (%) Positive (%) Negative (%) Age group 1.000 13–29 78 (63.9) 44 (36.1) 0.25 6 (4.9) 116 (95.1) ≥30 156 (57.8) 114 (42.2) 14 (5.2) 256 (94.8) Sex 0.46 Male 66 (55) 54 (45) 0.21 8 (6.7) 112 (93.3) Female 168 (61.8) 104 (38.2) 12 (4.4) 260 (95.6) Education 0.25 ≤Primary 114 (64) 64 (36) 0.11 12 (6.7) 166 (93.3) ≥Secondary 120 (56.1) 94(43.9) 8 (3.7) 206 (96.3) Marital status 1.000 Single 46 (59) 32 (41) 0.89 4 (5.1) 74 (94.9) Married 188 (59.9) 126 (40.1) 16 (5.1) 298 (94.9) Occupation 0.019 Informal sector 184 (57.9) 134 (42.1) 0.13 20 (6.3) 298 (93.7) Formal sector 50 (67.6) 24 (32.4) 0 (0) 74 (100) ITN use 0.001 Yes 0 (0) 0 (0) 0 (0) 348 (100) No 234 (59.7) 158 (40.3) 20 (45.5) 24 (54.5) Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 5 of 6 http://www.apfmj.com/content/12/1/2 ITN use at night and malaria preventive education. Osun State, Nigeria. Areas of research interest include communicable and non communicable diseases, family issues; NAA lectures at Department of This was due to strict adherence to instructions given O&G, Osun State University, Osogbo, Nigeria. Areas of research interest by their healthcare workers. This could be explained include reproductive and infection epidemiology, gynaecological by higher formal education and better environmental diseases; EAA is an associate professor at the Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi conditions of respondents working in the formal sec- Awolowo University, Ile-Ife, Osun State, Nigeria. Areas of research interest tor. Studies had reported the positive influence of for- include communicable and non communicable diseases, family issues; mal education on adherence to malaria preventive ISM is a medical officer at the Antiretroviral clinic, State hospital, Osogbo, Nigeria. messages [2,4]. Study site: Antiretroviral clinic, State hospital, Osogbo, Osun state, Nigeria Also this study found that more than two-fifth of re- spondents who were not using ITN had malaria para- Acknowledgement sitemia at third month follow up. This implies that The authors wish to thank the entire staff and patients of the ARV clinic for their support and cooperation during the study period. ITN use prevent exposure to mosquito bite hence thwarting the plasmodium organism transmission. Author details Various studies had reported that mosquito bite is ne- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Department of Obstetrics cessary for the transmission of the plasmodium organ- and Gynaecology, Osun State University, Osogbo, Osun state, Nigeria. ism [11-13]. Antiretroviral clinic, State hospital, Osogbo, Osun state, Nigeria. This study reported that the main reasons for inconsist- Received: 19 January 2012 Accepted: 19 June 2013 ent or non-use of ITN included night duty and reaction to Published: 22 June 2013 permethrin embedded in the net. Permethrin impregnated ITN had been shown in various studies to prevent the References plasmodium transmission however reaction to this chem- 1. Asamoah-Odei E, Garcia Calleja JM, Boerma JT: HIV prevalence and trends in sub-Saharan Africa: no decline and large sub regional differences. ical agent cannot be foreclosed [13,14]. Since the most im- Lancet 2004, 364:35–40. portant prevention against malaria is to avoid the infected 2. Federal Ministry of Health: Malaria Control In Nigeria A Strategy For Behaviour bite from the mosquito which is only possible when the Change Communication 2004 – 2005. 2004:5–29. http://www.jhpiego.org/ files/malarialrp/english/programResources/files/ individual actually slept under a properly deployed net Communication_Strategy_Nigeria_MIP_only.pdf. during the night [13,15]. Also the PLWHA on night duty 3. WHO: Malaria and HIV/AIDS interactions and implications: conclusions of a could cover the exposed parts of their body to prevent ex- technical consultation convened. WHO; 2004:1–2. http://whqlibdoc.who.int/ hq/2004/WHO_HIV_2004.08_eng.pdf. posure to mosquito bite during this period while people 4. Federal Ministry of Health, National Malaria Control Programme, Abuja: A5- who never liked sleeping under the ITN need further mal- year Strategic Plan: 2006-2010. A Road Map for Impact on Malaria in Nigeria. aria preventive education to see the merits of preventing Rapid Scale up of Malaria Control Interventions for Impact in Nigeria; 2005:1–50. http://www.rbm.who.int/countryaction/nsp/nigeria.pdf. exposure to the plasmodium organism through sleeping 5. Korenromp EL, Williams BG, de Vlas SJ, Gouws E, Gilks CF, Ghys PD, Nahlen under the ITN every night. BL, Korenromp EL, Williams BG, de Vlas SJ, Gouws E, Gilks CF, Ghys PD, Limitation to the study is that it is a preliminary study Nahlen BL: Malaria attributable to the HIV-1 epidemic, Sub-Saharan Africa. Emerg Infect Dis 2005, 11(9):1410–1418. www.cdc.gov/eid. on effect of preventive education and ITN use on mal- 6. Goselle ON, Onwuliri COE, Onwuliri VA: Malaria infection in HIV/AIDS aria parasitemia among PLWHA. Also, a convenience patients and its correlation with packed cell volume. J Vector Borne Dis sample of PLWHA was selected. 2009, 46:205–211. 7. Kish, Leslie: Survey sampling. N.Y: John Wiley and Sons; 1965. 8. Saracino A, Nacarapa EA, Massinga EC, Martinelli D, Scacchetti M, Oliveira D, Antonich A, Galloni D, Ferro JJ, Macome CA: Prevalence and clinical Conclusion features of HIV and malaria co-infection in hospitalized adults in Beira, Mozambique. Malar J 2012, 11:241. Preventive education and consistent ITN use reduced 9. Olajide FO, Afolabi OT, Olajide AO, Omisore AG, Omomuniniyi OA: malaria infection among PLWHA. There should be on- Challenges with the use of insecticide treated nets among pregnant going preventive education on malaria with free women in Ife-Ijesha zone, southwestern Nigeria. J Community Med Prim Health Care 2011, 23(1&2):79–86. provision of ITN with home visits by healthcare workers 10. World Health Organization: Malaria and HIV interactions and their targeted at ensuring adherence to ITN use. implications for public health policy. 2005:9–44. http://www.who.int/hiv/pub/ prev_care/malariahiv.pdf. Competing interest 11. Whitworth J, Morgan D, Quigley M, Smith A, Mayanja B, Eotu H, et al: Effect The authors declare that they have no competing interests. of HIV-1 and increasing immunosupression on malaria parasitemia and clinical episode in adults in rural Uganda: a cohort study. Lancet 2000, Authors’ contributions 356:1051–1056. SAO and NAA made substantial contributions to conception and design of 12. Leaver RJ, Haile Z, Watter DA: HIV and cerebral malaria. Trans R Soc Trop the study while all the authors were involved in data collection, analysis and Med Hyg 1990, 84:201. interpretation. All authors were involved in writing the manuscript and 13. Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, Phillips-Howard PA, et al: approved the final copy. Impact of permethrin treated bed nets on entomological indices in an area of intense year round malaria transmission. Am J Trop Med Hyg 2003, Authors’ information 68(Suppl 4):16–22. SAO lectures at Department of Community Health, Faculty of Clinical 14. Lengeler C: Insecticide-treated bed nets and curtains for preventing Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, malaria. Cochrane Database Syst Rev 2004, 2, CD000363. Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 6 of 6 http://www.apfmj.com/content/12/1/2 15. Kulkarni MA, Malima R, Mosha FW, Msangi S, Mrema E, Kabula B, Lawrence B, Kinung’hi S, Swilla J, Kisinza W, Rau1 ME, Miller JE, Schellenberg JA, Maxwell C, Rowland M, Magesa S, Drakeley C: Efficacy of pyrethroid- treated nets against malaria vectors and nuisance-biting mosquitoes in Tanzania in areas with long-term insecticide-treated net use. Trop Med Int Health 2007, 12(9):1061–1073. doi:10.1186/1447-056X-12-2 Cite this article as: Olowookere et al.: Use of insecticide treated net and malaria preventive education: effect on malaria parasitemia among people living with AIDS in Nigeria, a cross-sectional study. Asia Pacific Family Medicine 2013 12:2. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

Use of insecticide treated net and malaria preventive education: effect on malaria parasitemia among people living with AIDS in Nigeria, a cross-sectional study

Loading next page...
 
/lp/springer-journals/use-of-insecticide-treated-net-and-malaria-preventive-education-effect-pZfBPA80a9
Publisher
Springer Journals
Copyright
Copyright © 2013 by Olowookere et al.; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1447-056X
DOI
10.1186/1447-056X-12-2
pmid
23800088
Publisher site
See Article on Publisher Site

Abstract

Background: Malaria and HIV are major causes of morbidity and mortality in sub-Saharan Africa with both diseases highly endemic in Nigeria. This study was conducted to assess the effect of long lasting insecticide treated net (ITN) use and malaria preventive education on burden of malaria parasite among people living with AIDS (PLWHA) at Osogbo southwestern Nigeria. Method: A descriptive cross-sectional study of newly recruited consenting PLWHA that were screened consecutively for malaria, those positive were treated with artemisinin combination therapy. All PLWHA were educated about malaria infection, given ITN and followed up monthly for three months when they were rescreened for malaria infection. Data collected was analyzed using descriptive and inferential statistics. Result: A total of 392 (92%) PLWHA completed the study. Mean age of the respondents was 33 ± 11.6 years. They were 120 (31%) males and 272 (69%) females. Majority (80%) were married, over 33% completed secondary education while 21% had tertiary education. Most were traders (40%) and artisans (25%). About 60% had Plasmodium falciparum malaria parasitemia at baseline which drastically reduced to 5% at three months with ITN use and malaria prevention education. Conclusion: Malaria is a major preventable condition among PLWHA. Preventive education and ITN use reduced malaria parasite burden among this population. Keywords: Malaria, PLWHA, ITN use, Preventive education Background and Plasmodium malariae [4]. Of these four species of Malaria and HIV/AIDS are leading causes of morbidity and plasmodium, Plasmodium falciparum causes the most mortality in sub-Saharan Africa [1]. Both diseases are highly severe malaria illness and death throughout the world. Plas- endemic in Nigeria [2]. Malaria is the most common life modium falciparum is known to be the most devastating in threatening infection with one million deaths per year, Nigeria [2]. Malaria is transmitted through the bite of an 300–500 million infections per year, about 90% of the death infected female anopheles mosquito [4]. occurring in sub-Saharan Africa [3]. Most victims were Nigeria accounts for a quarter of all malaria cases in the children less than 5 years of age and pregnant women [3]. World Health Organization African Region [2]. It is en- Human malaria is a parasitic infection caused by Plasmo- demic throughout the country with more than 90% of the dium falciparum, Plasmodium vivax, Plasmodium ovale total population at risk of stable endemic malaria. At least 50% of the population suffers from at least one episode of malaria each year [4]. Transmission in the south occurs * Correspondence: sanuolowookere@yahoo.com Department of Community Health, College of Health Sciences, Obafemi all-year round, and is more seasonal in the north [4]. Al- Awolowo University, Ile-Ife, Osun State, Nigeria most all cases are caused by P. falciparum but most are Full list of author information is available at the end of the article © 2013 Olowookere et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 2 of 6 http://www.apfmj.com/content/12/1/2 unconfirmed [4]. There is no evidence of a systematic de- monthly while very ill patients were admitted into the cline in malaria burden; the upward trend in numbers of hospital medical wards. cases and deaths is probably due to improvements in reporting [4]. Study design HIV infection increases the risk and severity of malaria This is a descriptive cross-sectional study from June to [3]. The population-level impact depends on HIV preva- December 2010. The study population included new lence, the age distribution of both infections which for PLWHA recruited consecutively by trained research assis- malaria is determined by the transmission intensity, and tants after they have consented to participate following their geographic overlap [5]. Local distributions of CD4 through explanation of the study by the researchers to cell counts and clinical stages of HIV-infected patients them and/or their family caregivers (where respondent are also important because the effects of HIV multiply was less than 18 years). The required sample size of 334 with increasing immunosuppression [3]. Studies on was calculated using an appropriate statistical formula for adults in areas of high malaria transmission showed that estimating the minimum sample size in descriptive health 2 2 HIV-1 infection increased case fatality among hospital- studies [n = Z pq/d ] [7] and finding from a previous study ized persons with severe malaria by 1.6- to 2.5- fold, [6] where 32% of PLWHA studied had malaria. The mini- while the incidence of severe malaria, a precursor of fatal mum sample size was increased by 10% to take care of in- episodes, increased by 2.7-fold. HIV-1 increases malaria complete/non response and refusals. The informed deaths by increasing the proportion of severe cases, case consent form and a pretested questionnaire that included fatality among them, and the failure rate of antimalarials information on biodata, awareness of malaria prevention, treatment. HIV-1 increased malaria incidence by 0.20% and previous ITN use were administered to the research to 28% across countries. HIV-1 increased malaria deaths participants and their family caregivers by the researchers by 0.65% to 114% across countries [5]. In HIV-infected at beginning of the study. These consenting PLWHA had adults, pregnant women, and children, malaria is among their blood film screened consecutively for malaria para- the simplest infections to prevent and treat [6]. site at the beginning of the study. The respondents that The malaria preventive health behaviour had been were malaria parasite positive were treated free with arte- found to be generally poor across Nigeria with less than misinin combination therapy regimen while all clients’ and 10% respondents using long lasting insecticide treated their family caregivers’ undergone education about malaria net (ITN) [2]. Malaria is a major public health problem and HIV infection. They were then given ITN free which in Nigeria, accounting for about 60% of all outpatient at- they were encouraged to sleep under every night. They tendances and 30% of all hospital admissions [4]. It is es- were followed up monthly for three months when they had timated that malaria is responsible for nearly 110 million their blood film rescreened for malaria parasite. The study clinical cases and an estimated 300,000 deaths per year, participants were also interviewed with these question- including up to 11% of maternal mortality [2]. naires during their monthly visits to the clinic. Also these This study was conducted to assess the effect of ITN use respondents were visited at home by the antiretroviral clinic and malaria preventive education on burden of malaria home visit team to ensure adherence to antiretroviral drug parasitemia among people living with AIDS (PLWHA) at therapy, cotrimoxazole, preventive education and ITN use. Osogbo southwestern Nigeria. Ethical consideration included taking informed con- sent from respondents and their family caregiver, using serial numbers and not names to maintain confidential- Methodology ity of information obtained. Permission to conduct the Study site study was granted by the Osun State Hospital Ethics and The antiretroviral (ARV) clinic located at State hospital Research Committee. Data collected were kept in a pass- Osogbo, Osun State, southwest Nigeria was established word computer. February 2009. The hospital is a free treatment General Data obtained was entered into SPSS version 16. Sum- hospital attending to about 10,000 patients weekly. The mary statistics using mean, median, standard deviation, ARV Clinic offers comprehensive HIV/AIDS care for all range for continuous variables and frequency/percent- the 31 local government health facilities in Osun State ages for categorical variables were generated. Chi square and beyond. This clinic is supported by the Osun State statistics was used to test association between categorical Ministry of Health in collaboration with Global HIV/ variables with p value less than 0.05 taken as significant. AIDS Initiative in Nigeria. PLWHA receive care and support including antiretroviral therapy at the clinic Results which opens every Mondays and Wednesdays from A total of 392 PLWHA out of 425 completed the study 8 am to 4 pm. It attends to 100–140 PLWHA weekly. (92%). Thirty-three respondents opted out of the study Patients on care were usually routinely followed up for personal reasons such as unscheduled traveling. No Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 3 of 6 http://www.apfmj.com/content/12/1/2 respondent died or were lost to follow up during Table 3 showed the respondent’s sociodemographic the study period. Mean age of the respondents was characteristics and malaria positivity at baseline and three 33 years ± 11.6 years (Range = 13-60 years). months follow up. Majority (68%) of the respondents in Table 1 reported the sociodemographic characteristics the formal sector was malaria parasite positive at baseline of respondents. They were 120 (31%) males and 272 but all were malaria parasite negative by third month. (69%) females. Majority were married (80%), 33% com- Over 45% of respondents who were not using ITN had pleted secondary education while 21% had tertiary edu- malaria parasitemia at third month follow up. cation. Most were traders (40%) and artisans (25%). At Common reasons for inconsistent or non use of ITN in- baseline all respondents saw malaria as a threat to good cluded night duty (39%), reaction to the permethrin em- health while 42% were aware that malaria could be bedded in the net (27%) while some respondents never prevented but none sleep under ITN at home. Reasons liked sleeping under ITN (23%). for non use of ITN were non availability (54%), exorbi- tant price (48%), and ignorance (22%). Only 15% used Discussion insecticide spray or coil which they said was inadequate This study assessed the effect of ITN use and malaria pre- as they still get malaria despite constant use. ventiveeducationon burdenof malaria parasitemia among Table 2 reported the pattern of malaria parasitemia people living with AIDS. It reported that preventive educa- and ITN use among the study participants. About 60% tion and ITN use reduced malaria parasitemia over a period had Plasmodium falciparum malaria parasitemia at base- of three months. The high malaria burden at baseline re- line which drastically reduced to 5% at three months duced remarkably by three months. Previous studies had with ITN use and malaria prevention education. Figure 1 shown this among pregnant women and children [2,4]. showed that PLWHA using ITN had no malaria parasit- Majority of the study population had malaria at base- emia at three months. line. This finding is expected as the study area is an area of intense year round malaria transmission. Goselle et al. Table 1 Sociodemographic characteristics of PLWHA in 2009 in a study on malaria infection among PLWHA attending State hospital, Osogbo in Jos, Nigeria reported 32% while Saracino et al. in Sociodemographic characteristics Frequency (N = 392) % 2012 reported 26% in Beira, Mozambique [6,8]. However Age group (years) a much higher burden was reported in the present study 13–18 30 7.7 because most PLWHA studied had no malaria prevent- 19–29 92 23.5 ive education and no access to ITN at baseline. Studies had shown that malaria if not treated and prevented will 30–39 166 42.3 further reduced the quality of life of these immunocom- ≥40 104 26.5 promised population [3,5,6]. Sex This study reported that ITN use protects against mal- Male 120 30.6 aria among the participants. This entails that malaria Female 272 69.4 preventive education and ITN should be routinely given Education to PLWHA to prevent malaria among them, thereby im- proving their quality of life. None 90 23.0 Primary 88 22.4 Table 2 Pattern of malaria parasitemia and ITN use Secondary 130 33.2 among PLWHA at state hospital, Osogbo, Nigeria Tertiary 84 21.4 Malaria parasite result/ITN use Frequency % Marital status Result at baseline Single 64 16.3 Positive 234 59.7 Married 314 80.1 Negative 158 40.3 Divorced/widowed 14 3.6 Result at three month Occupation Positive 20 5.1 Trading 158 40.3 Negative 372 94.9 Civil servant 56 14.3 ITN given at baseline Artisan 98 25.0 Yes 392 100 Police 18 4.6 ITN use at 3 months Clergy 6 1.5 Yes 348 88.8 Unemployed 56 14.3 No 44 11.2 Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 4 of 6 http://www.apfmj.com/content/12/1/2 PLWHA N=392 Malaria Malaria (-), (+), N=234 N=158 ITN use (+), ITN use (+), ITN use (-), ITN use (-), N=137 N=211 N=21 N=23 Malaria Malaria (-), Malaria Malaria Malaria (-), Malaria Malaria (-), Malaria (+), N=0 (-), (+), N=9 N=12 N=211 (+), N=12 (+), N=0 N=137 N=11 Figure 1 Flowchart of ITN use and malaria parasitemia among PLWHA. Most respondents gave financial constraints and non This study further showed that consenting PLWHA availability as their reason for non use of ITN at baseline. should be routinely visited at home to observe the con- Various studies on challenges to ITN use in this environ- ditions they lived. This will improve relationship be- ment had reported this finding. For example, Olajide et al. tween these PLWHA and the healthcare team. Studies in a study on challenges with ITN use among pregnant had showed that the living conditions of patients affect women reported that pregnant women did not sleep their health and that improving these living conditions under ITN because of non availability (53%) and cost will improve their quality of life [4,10]. (24%) [9]. This implied that ITN must be made available This study also reported that the respondents working and affordable or free to all PLWHA to reduce malaria in the formal sector with high parasitemia at baseline had burden among them. no malaria parasitemia after three months of continuous Table 3 Respondent’s sociodemographic characteristics and malaria positivity at baseline and three months follow up Characteristics Malaria parasite (baseline) p value Malaria parasite (3rd month) p value Positive (%) Negative (%) Positive (%) Negative (%) Age group 1.000 13–29 78 (63.9) 44 (36.1) 0.25 6 (4.9) 116 (95.1) ≥30 156 (57.8) 114 (42.2) 14 (5.2) 256 (94.8) Sex 0.46 Male 66 (55) 54 (45) 0.21 8 (6.7) 112 (93.3) Female 168 (61.8) 104 (38.2) 12 (4.4) 260 (95.6) Education 0.25 ≤Primary 114 (64) 64 (36) 0.11 12 (6.7) 166 (93.3) ≥Secondary 120 (56.1) 94(43.9) 8 (3.7) 206 (96.3) Marital status 1.000 Single 46 (59) 32 (41) 0.89 4 (5.1) 74 (94.9) Married 188 (59.9) 126 (40.1) 16 (5.1) 298 (94.9) Occupation 0.019 Informal sector 184 (57.9) 134 (42.1) 0.13 20 (6.3) 298 (93.7) Formal sector 50 (67.6) 24 (32.4) 0 (0) 74 (100) ITN use 0.001 Yes 0 (0) 0 (0) 0 (0) 348 (100) No 234 (59.7) 158 (40.3) 20 (45.5) 24 (54.5) Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 5 of 6 http://www.apfmj.com/content/12/1/2 ITN use at night and malaria preventive education. Osun State, Nigeria. Areas of research interest include communicable and non communicable diseases, family issues; NAA lectures at Department of This was due to strict adherence to instructions given O&G, Osun State University, Osogbo, Nigeria. Areas of research interest by their healthcare workers. This could be explained include reproductive and infection epidemiology, gynaecological by higher formal education and better environmental diseases; EAA is an associate professor at the Department of Community Health, Faculty of Clinical Sciences, College of Health Sciences, Obafemi conditions of respondents working in the formal sec- Awolowo University, Ile-Ife, Osun State, Nigeria. Areas of research interest tor. Studies had reported the positive influence of for- include communicable and non communicable diseases, family issues; mal education on adherence to malaria preventive ISM is a medical officer at the Antiretroviral clinic, State hospital, Osogbo, Nigeria. messages [2,4]. Study site: Antiretroviral clinic, State hospital, Osogbo, Osun state, Nigeria Also this study found that more than two-fifth of re- spondents who were not using ITN had malaria para- Acknowledgement sitemia at third month follow up. This implies that The authors wish to thank the entire staff and patients of the ARV clinic for their support and cooperation during the study period. ITN use prevent exposure to mosquito bite hence thwarting the plasmodium organism transmission. Author details Various studies had reported that mosquito bite is ne- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria. Department of Obstetrics cessary for the transmission of the plasmodium organ- and Gynaecology, Osun State University, Osogbo, Osun state, Nigeria. ism [11-13]. Antiretroviral clinic, State hospital, Osogbo, Osun state, Nigeria. This study reported that the main reasons for inconsist- Received: 19 January 2012 Accepted: 19 June 2013 ent or non-use of ITN included night duty and reaction to Published: 22 June 2013 permethrin embedded in the net. Permethrin impregnated ITN had been shown in various studies to prevent the References plasmodium transmission however reaction to this chem- 1. Asamoah-Odei E, Garcia Calleja JM, Boerma JT: HIV prevalence and trends in sub-Saharan Africa: no decline and large sub regional differences. ical agent cannot be foreclosed [13,14]. Since the most im- Lancet 2004, 364:35–40. portant prevention against malaria is to avoid the infected 2. Federal Ministry of Health: Malaria Control In Nigeria A Strategy For Behaviour bite from the mosquito which is only possible when the Change Communication 2004 – 2005. 2004:5–29. http://www.jhpiego.org/ files/malarialrp/english/programResources/files/ individual actually slept under a properly deployed net Communication_Strategy_Nigeria_MIP_only.pdf. during the night [13,15]. Also the PLWHA on night duty 3. WHO: Malaria and HIV/AIDS interactions and implications: conclusions of a could cover the exposed parts of their body to prevent ex- technical consultation convened. WHO; 2004:1–2. http://whqlibdoc.who.int/ hq/2004/WHO_HIV_2004.08_eng.pdf. posure to mosquito bite during this period while people 4. Federal Ministry of Health, National Malaria Control Programme, Abuja: A5- who never liked sleeping under the ITN need further mal- year Strategic Plan: 2006-2010. A Road Map for Impact on Malaria in Nigeria. aria preventive education to see the merits of preventing Rapid Scale up of Malaria Control Interventions for Impact in Nigeria; 2005:1–50. http://www.rbm.who.int/countryaction/nsp/nigeria.pdf. exposure to the plasmodium organism through sleeping 5. Korenromp EL, Williams BG, de Vlas SJ, Gouws E, Gilks CF, Ghys PD, Nahlen under the ITN every night. BL, Korenromp EL, Williams BG, de Vlas SJ, Gouws E, Gilks CF, Ghys PD, Limitation to the study is that it is a preliminary study Nahlen BL: Malaria attributable to the HIV-1 epidemic, Sub-Saharan Africa. Emerg Infect Dis 2005, 11(9):1410–1418. www.cdc.gov/eid. on effect of preventive education and ITN use on mal- 6. Goselle ON, Onwuliri COE, Onwuliri VA: Malaria infection in HIV/AIDS aria parasitemia among PLWHA. Also, a convenience patients and its correlation with packed cell volume. J Vector Borne Dis sample of PLWHA was selected. 2009, 46:205–211. 7. Kish, Leslie: Survey sampling. N.Y: John Wiley and Sons; 1965. 8. Saracino A, Nacarapa EA, Massinga EC, Martinelli D, Scacchetti M, Oliveira D, Antonich A, Galloni D, Ferro JJ, Macome CA: Prevalence and clinical Conclusion features of HIV and malaria co-infection in hospitalized adults in Beira, Mozambique. Malar J 2012, 11:241. Preventive education and consistent ITN use reduced 9. Olajide FO, Afolabi OT, Olajide AO, Omisore AG, Omomuniniyi OA: malaria infection among PLWHA. There should be on- Challenges with the use of insecticide treated nets among pregnant going preventive education on malaria with free women in Ife-Ijesha zone, southwestern Nigeria. J Community Med Prim Health Care 2011, 23(1&2):79–86. provision of ITN with home visits by healthcare workers 10. World Health Organization: Malaria and HIV interactions and their targeted at ensuring adherence to ITN use. implications for public health policy. 2005:9–44. http://www.who.int/hiv/pub/ prev_care/malariahiv.pdf. Competing interest 11. Whitworth J, Morgan D, Quigley M, Smith A, Mayanja B, Eotu H, et al: Effect The authors declare that they have no competing interests. of HIV-1 and increasing immunosupression on malaria parasitemia and clinical episode in adults in rural Uganda: a cohort study. Lancet 2000, Authors’ contributions 356:1051–1056. SAO and NAA made substantial contributions to conception and design of 12. Leaver RJ, Haile Z, Watter DA: HIV and cerebral malaria. Trans R Soc Trop the study while all the authors were involved in data collection, analysis and Med Hyg 1990, 84:201. interpretation. All authors were involved in writing the manuscript and 13. Gimnig JE, Vulule JM, Lo TQ, Kamau L, Kolczak MS, Phillips-Howard PA, et al: approved the final copy. Impact of permethrin treated bed nets on entomological indices in an area of intense year round malaria transmission. Am J Trop Med Hyg 2003, Authors’ information 68(Suppl 4):16–22. SAO lectures at Department of Community Health, Faculty of Clinical 14. Lengeler C: Insecticide-treated bed nets and curtains for preventing Sciences, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, malaria. Cochrane Database Syst Rev 2004, 2, CD000363. Olowookere et al. Asia Pacific Family Medicine 2013, 12:2 Page 6 of 6 http://www.apfmj.com/content/12/1/2 15. Kulkarni MA, Malima R, Mosha FW, Msangi S, Mrema E, Kabula B, Lawrence B, Kinung’hi S, Swilla J, Kisinza W, Rau1 ME, Miller JE, Schellenberg JA, Maxwell C, Rowland M, Magesa S, Drakeley C: Efficacy of pyrethroid- treated nets against malaria vectors and nuisance-biting mosquitoes in Tanzania in areas with long-term insecticide-treated net use. Trop Med Int Health 2007, 12(9):1061–1073. doi:10.1186/1447-056X-12-2 Cite this article as: Olowookere et al.: Use of insecticide treated net and malaria preventive education: effect on malaria parasitemia among people living with AIDS in Nigeria, a cross-sectional study. Asia Pacific Family Medicine 2013 12:2. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

Journal

Asia Pacific Family MedicineSpringer Journals

Published: Jun 22, 2013

References