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      Knowledge, attitudes, and practices regarding malaria control among the slash and burn cultivators in Rangamati Hill tracts of Bangladesh

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          Abstract

          Background

          Slash and burn cultivators are a significant risk group for malaria in South-East Asia. As envisaged in the National Strategic Plan for Malaria Elimination, Bangladesh aims to achieve zero indigenous malaria transmission by 2030. For the national plan to move from malaria control to malaria elimination, targeting the population of slash and burn cultivators is of overriding importance.

          Methods

          The study used an explorative mixed method design to investigate the knowledge, attitudes, and practices (KAP) regarding malaria prevention and treatment in an endemic area of Bangladesh. Adult slash and burn cultivators in two sub-districts of the Rangamati District were selected and interviewed. Four focus group discussions were conducted, and this was followed by a cross-sectional quantitative survey with 200 participants.

          Results

          The respondents’ general knowledge about malaria transmission and modes of prevention and treatment was good. However, there were some gaps regarding knowledge about specific aspects of malaria transmission and in particular about the increased risk associated with their occupation. Despite a much-reduced incidence of malaria in the study area, the respondents perceived the disease as life-threatening and knew that it needs rapid attention from a health worker. Moreover, the specific services offered by the local community health workers for malaria diagnosis and treatment were highly appreciated. Finally, the use of insecticide-treated mosquito nets (ITN) was considered as important and this intervention was uniformly stated as the main malaria prevention method.

          Conclusions

          The findings from this study on promising KAP characteristics in the slash and burn cultivator population are reassuring that the goal of malaria elimination by the year 2030 can be achieved in Bangladesh.

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          Most cited references27

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          Sampling hard to reach populations.

          Studies on 'hidden populations', such as homeless people, prostitutes and drug addicts, raise a number of specific methodological questions usually absent from research involving known populations and less sensitive subjects. This paper examines the advantages and limitations of nonrandom methods of data collection such as snowball sampling. It reviews the currently available literature on sampling hard to reach populations and highlights the dearth of material currently available on this subject. The paper also assesses the potential for using these methods in nursing research. The sampling methodology used by Faugier (1996) in her study of prostitutes, HIV and drugs is used as a current example within this context.
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            Malaria: ethnomedical perceptions and practice in an Adangbe farming community and implications for control.

            I Agyepong (1992)
            Malaria is a parasitic disease about which there is much bio-medical knowledge on causation, prevention, treatment and control. Attempts at eradication, as well as control in the past has been mainly a technical and bio-medical endeavour. With the policy shift from world wide eradication of malaria to control as part of primary health care, there is increasing interest in studying all possible determinants of the problem at local as well as regional levels as part of the search for an effective intervention. This paper presents the results of a study into community perceptions and practice relating to causation, treatment and prevention of malaria in a rural Adangbe farming community in Southern Ghana. Malaria is common in this community. Crude parasite rates among adolescent girls (10-19 years old) in the community were 49% towards the end of the major rainy season, and 47% in the early dry season. The symptoms and signs of the disease are readily described by lay people as well as traditional healers. Diagnosis and treatment of uncomplicated episodes of malaria at home, according to ethnomedical perceptions, is the predominant behaviour in this community. Very few cases of uncomplicated malaria are sent to health facilities. Ethnomedical perceptions of malaria causation and treatment on which this self care is based, are different from conventional biomedical ones. Malaria is perceived as an environmentally related disease caused by excessive contact with external heat which upsets the blood equilibrium. Many community members do not connect it with the mosquito in theory or practice. Implications for approaches to control are discussed.
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              Mosquito repellents for malaria prevention

              Background Malaria is an important cause of illness and death across endemic regions. Considerable success against malaria has been achieved within the past decade mainly through long-lasting insecticide-treated nets (LLINs). However, elimination of the disease is proving difficult as current control methods do not protect against mosquitoes biting outdoors and when people are active. Repellents may provide a personal protection solution during these times. Objectives To assess the impact of topical repellents, insecticide-treated clothing, and spatial repellents on malaria transmission. Search methods We searched the following databases up to 26 June 2017: the Cochrane Infectious Diseases Group Specialized Register; the Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; US AFPMB; CAB Abstracts; and LILACS. We also searched trial registration platforms and conference proceedings; and contacted organizations and companies for ongoing and unpublished trials. Selection criteria We included randomized controlled trials (RCTs) and cluster-randomized controlled trials of topical repellents proven to repel mosquitoes; permethrin-treated clothing; and spatial repellents such as mosquito coils. We included trials that investigated the use of repellents with or without LLINs, referred to as insecticide-treated nets. Data collection and analysis Two review authors independently reviewed trials for inclusion, extracted the data, and assessed the risk of bias. A third review author resolved any discrepancies. We analysed data by conducting meta-analysis and stratified by whether the trials had included LLINs. We combined results from cRCTs with individually RCTs by adjusting for clustering and presented results using forest plots. We used GRADE to assess the certainty of the evidence. Main results Eight cRCTs and two RCTs met the inclusion criteria. Six trials investigated topical repellents, two trials investigated insecticide-treated clothing, and two trials investigated spatial repellents. Topical repellents Six RCTS, five of them cluster-randomized, investigated topical repellents involving residents of malaria-endemic regions. Four trials used topical repellents in combination with nets, but two trials undertaken in displaced populations used topical repellents alone. It is unclear if topical repellents can prevent clinical malaria (RR 0.65, 95% CI 0.4 to 1.07, very low certainty evidence) or malaria infection (RR 0.84, 95% CI 0.64 to 1.12, low-certainty evidence) caused by P. falciparum. It is also unclear if there is any protection against clinical cases of P. vivax (RR 1.32, 95% CI 0.99 to 1.76, low-certainty evidence) or incidence of infections (RR 1.07, 95% CI 0.80 to 1.41, low-certainty evidence). Subgroup analysis of trials including insecticide-treated nets did not show a protective effect of topical repellents against malaria. Only two studies did not include insecticide-treated nets, and they measured different outcomes; one reported a protective effect against clinical cases of P. falciparum (RR 0.40, 95% CI 0.23 to 0.71); but the other study measured no protective effect against malaria infection incidence caused by either P. falciparum or P. vivax. Insecticide-treated clothing Insecticide-treated clothing were investigated in trials conducted in refugee camps in Pakistan and amongst military based in the Colombian Amazon. Neither study provided participants with insecticide-treated nets. In the absence of nets, treated clothing may reduce the incidence of clinical malaria caused by P. falciparum by approximately 50% (RR 0.49, 95% CI 0.29 to 0.83, low-certainty evidence) and P. vivax (RR 0.64, 95% CI 0.40 to 1.01, low-certainty evidence). Spatial repellents Two cluster-randomized RCTs investigated mosquito coils for malaria prevention. We do not know the effect of spatial repellents on malaria prevention (RR 0.24, 95% CI 0.03 to 1.72, very low certainty evidence). There was large heterogeneity between studies and one study had high risk of bias. Authors' conclusions There is insufficient evidence to conclude topical or spatial repellents can prevent malaria. There is a need for better designed trials to generate higher certainty of evidence before well-informed recommendations can be made. Adherence to daily compliance remains a major limitation. Insecticide-treated clothing may reduce risk of malaria infection in the absence of insecticide-treated nets; further studies on insecticide-treated clothing in the general population should be done to broaden the applicability of the results. Mosquito repellents for malaria prevention What was the aim of this review? The aim of this Cochrane Review was to find out if mosquito repellents — topical repellents (applied to the skin); insecticide-treated clothing; or spatial repellents such as mosquito coils — can prevent malaria. We collected and analysed the results of all relevant studies to answer this question and found data from ten trials: six on topical repellents, two on insecticide-treated clothing, and two on spatial repellents. Key messages We do not know if the use of repellent lotions or burning of mosquito coils can provide protection from malaria to communities living in endemic regions. In situations where long-lasting insecticide-treated bed nets (LLINs) cannot be rolled out, such as after a natural disaster or amongst displaced populations, the use of insecticide-treated clothing may reduce the risk of malaria infection by 50%. Most studies included in our analysis were poorly designed and had high risk of bias. In order to draw well-informed conclusions, further high-quality studies must be conducted to improve the certainty of the evidence. However, it is questionable if topical repellents can be used for malaria prevention in the general population as daily compliance and poor standardization (amount of repellent used, surface area applied, time of application, and period between repeated applications) are major limitations of this intervention. What was studied in this review Mosquito repellents provide protection from mosquito bites. There are three different types of repellents: topical repellents, which can be applied on the skin; insecticide-treated clothing, through impregnation of clothing with repellent compounds; and spatial repellents, such as mosquito coils. Malaria has decreased in many countries because people have been given highly effective LLINs. However people are still being bitten before they go to bed. There is a need to find a way to offer protection from malaria during these hours. Mosquito repellents may address this gap. What are the main results of the review? A total of six trials investigated the use of topical repellents for malaria prevention. The trials took place in different malaria-endemic regions across South America, Asia, and sub-Saharan Africa. The topical repellents tested included lotions, treated soap, and local cosmetics. We analysed the studies in groups according to LLIN inclusion. Most studies rolled out LLINs to the population and investigated topical repellents as a complementary intervention to the treated bed-nets. The poor design of the included studies provided low to very low certainty evidence, consequently we do not know if there is a benefit of using topical repellents in addition to LLINs to prevent malaria. The compliance of participants to adhere to the daily application of repellents remains a challenge to further research. Insecticide-treated clothing was investigated in two trials conducted with refugees in Pakistan and military deployed in the Amazon; neither study rolled out or reported the use of bed-nets. In the absence of LLINs, there is some evidence that insecticide-treated clothing may reduce the risk of malaria infection by 50%. Given that the findings relate to special populations living in particularly harsh conditions it is unclear if the results are applicable to the general population. Further studies involving civilian populations should be done to improve the certainty of these findings. Two studies investigated the practice of burning mosquito coils to reduce malaria infections. One study was conducted in China and the other in Indonesia. The study designs were substantially different and one study had high risk of bias leading to very low certainty evidence. We do not know if mosquito coils offer protection against malaria. The findings underline the need for further research. How up to date is this review? The review authors searched for studies that had been published up to 26 June 2017.
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                Author and article information

                Contributors
                olaf.mueller@urz.uni-heidelberg.de
                Journal
                Malar J
                Malar. J
                Malaria Journal
                BioMed Central (London )
                1475-2875
                25 June 2019
                25 June 2019
                2019
                : 18
                : 216
                Affiliations
                [1 ]ISNI 0000 0001 2190 4373, GRID grid.7700.0, Heidelberg Institute of Global Health, Medical School, , Ruprecht-Karls-University, ; INF 130.3, 69120 Heidelberg, Germany
                [2 ]ISNI 0000 0001 0746 8691, GRID grid.52681.38, James P Grant School of Public Health, BRAC University, ; 68, Shaheed Tajuddin Ahmed Sharani, icddr,b Building, Level 6, Mohakhali, Dhaka, 1212 Bangladesh
                [3 ]ISNI 0000 0001 0745 3561, GRID grid.501438.b, BRAC, “BRAC Centre”, ; 75 Mohakhali, Dhaka, 1212 Bangladesh
                [4 ]GRID grid.268415.c, Medical College of Yangzhou University, Yangzhou University, ; Yangzhou, 225001 China
                Article
                2849
                10.1186/s12936-019-2849-0
                6593565
                31238990
                5ec58089-19a7-40b3-9b0c-9f69febb8ec1
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 11 January 2019
                : 19 June 2019
                Categories
                Research
                Custom metadata
                © The Author(s) 2019

                Infectious disease & Microbiology
                kap study,malaria,slash and burn cultivator,risk factors,bangladesh

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