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      Mosquito Net Ownership, Utilization, and Preferences among Mobile and Migrant Populations Sleeping in Forests and Farms in Central Vietnam: A Cross-Sectional Study

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          ABSTRACT

          Strengthening vector control measures among mobile and migrant populations (MMPs) is crucial to malaria elimination, particularly in areas with multidrug-resistant malaria. Although a global priority, providing access and ensuring high coverage of available tools such as long-lasting insecticidal nets (LLINs) among these vulnerable groups remains a significant challenge. We assessed mosquito net ownership, utilization, and preference among individuals who slept in a forest and/or on a farm against those residing only in village “home” settings in a priority malaria elimination area of Vietnam. Proportions of respondents owning bed nets were similar among forest, farm, and home sleeping sites, ranging between 96% and 98%. The proportion of respondents owning hammock nets was higher for the forest group (92%), whereas ownership of hammocks in general was significantly lower for the home group (55%). Most respondents (97%) preferred to bring hammock nets to their remote sleeping site, whereas a smaller proportion (25%) also considered bed nets as an option. Respondent preferences included thick hammock nets with zippers (53%), hammocks with a flip cover (17%), and thin hammock nets with zippers (15%), with none choosing polyethylene (hard) LLINs. Although there is high coverage and access to nets for this high-priority MMP group, there was a noted gap between coverage and net use, potentially undermining the effectiveness of net-related interventions that could impact malaria prevention and elimination efforts in Vietnam. The design and material of nets are important factors for user preferences that appear to drive net use.

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          The changing epidemiology of malaria elimination: new strategies for new challenges.

          Malaria-eliminating countries achieved remarkable success in reducing their malaria burdens between 2000 and 2010. As a result, the epidemiology of malaria in these settings has become more complex. Malaria is increasingly imported, caused by Plasmodium vivax in settings outside sub-Saharan Africa, and clustered in small geographical areas or clustered demographically into subpopulations, which are often predominantly adult men, with shared social, behavioural, and geographical risk characteristics. The shift in the populations most at risk of malaria raises important questions for malaria-eliminating countries, since traditional control interventions are likely to be less effective. Approaches to elimination need to be aligned with these changes through the development and adoption of novel strategies and methods. Knowledge of the changing epidemiological trends of malaria in the eliminating countries will ensure improved targeting of interventions to continue to shrink the malaria map. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Malaria management: past, present, and future.

            The prospect of malaria eradication has been raised recently by the Bill and Melinda Gates Foundation with support from the international community. There are significant lessons to be learned from the major successes and failures of the eradication campaign of the 1960s, but cessation of transmission in the malaria heartlands of Africa will depend on a vaccine and better drugs and insecticides. Insect control is an essential part of reducing transmission. To date, two operational scale interventions, indoor residual spraying and deployment of long-lasting insecticide-treated nets (LLINs), are effective at reducing transmission. Our ability to monitor and evaluate these interventions needs to be improved so that scarce resources can be sensibly deployed, and new interventions that reduce transmission in a cost-effective and efficient manner need to be developed. New interventions could include using transgenic mosquitoes, larviciding in urban areas, or utilizing cost-effective consumer products. Alongside this innovative development agenda, the potential negative impact of insecticide resistance, particularly on LLINs, for which only pyrethroids are available, needs to be monitored.
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              Malaria in the Greater Mekong Subregion: heterogeneity and complexity.

              The Greater Mekong Subregion (GMS), comprised of six countries including Cambodia, China's Yunnan Province, Lao PDR, Myanmar (Burma), Thailand and Vietnam, is one of the most threatening foci of malaria. Since the initiation of the WHO's Mekong Malaria Program a decade ago, malaria situation in the GMS has greatly improved, reflected in the continuous decline in annual malaria incidence and deaths. However, as many nations are moving towards malaria elimination, the GMS nations still face great challenges. Malaria epidemiology in this region exhibits enormous geographical heterogeneity with Myanmar and Cambodia remaining high-burden countries. Within each country, malaria distribution is also patchy, exemplified by 'border malaria' and 'forest malaria' with high transmission occurring along international borders and in forests or forest fringes, respectively. 'Border malaria' is extremely difficult to monitor, and frequent malaria introductions by migratory human populations constitute a major threat to neighboring, malaria-eliminating countries. Therefore, coordination between neighboring countries is essential for malaria elimination from the entire region. In addition to these operational difficulties, malaria control in the GMS also encounters several technological challenges. Contemporary malaria control measures rely heavily on effective chemotherapy and insecticide control of vector mosquitoes. However, the spread of multidrug resistance and potential emergence of artemisinin resistance in Plasmodium falciparum make resistance management a high priority in the GMS. This situation is further worsened by the circulation of counterfeit and substandard artemisinin-related drugs. In most endemic areas of the GMS, P. falciparum and Plasmodium vivax coexist, and in recent malaria control history, P. vivax has demonstrated remarkable resilience to control measures. Deployment of the only registered drug (primaquine) for the radical cure of vivax malaria is severely undermined due to high prevalence of glucose-6-phosphate dehydrogenase deficiency in target human populations. In the GMS, the dramatically different ecologies, diverse vector systems, and insecticide resistance render traditional mosquito control less efficient. Here we attempt to review the changing malaria epidemiology in the GMS, analyze the vector systems and patterns of malaria transmission, and identify the major challenges the malaria control community faces on its way to malaria elimination. Copyright © 2011 Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Am J Trop Med Hyg
                Am J Trop Med Hyg
                tpmd
                tropmed
                The American Journal of Tropical Medicine and Hygiene
                The American Society of Tropical Medicine and Hygiene
                0002-9637
                1476-1645
                May 2021
                05 April 2021
                05 April 2021
                : 104
                : 5
                : 1917-1924
                Affiliations
                [1 ]Vysnova Partners, Inc., Landover, Maryland;
                [2 ]National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam;
                [3 ]U.S. Naval Medical Research Unit TWO, Singapore
                Author notes
                [* ]Address correspondence to Gerard C. Kelly, Vysnova Partners, Inc., 8400 Corporate Dr., Suite 130, Landover, MD 20875. E-mail: gerardckelly@ 123456gmail.com

                Disclosure: All authors and institutes consent to publication. For K. A. E. and N. J. M.: I am a military Service member. This work was prepared as part of my official duties. Title 17, U.S.C., §105 provides that copyright protection under this title is not available for any work of the U.S. government. Title 17, U.S.C., §101 defines a U.S. government work as a work prepared by a military Service member or employee of the U.S. government as part of that person’s official duties.

                Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. government.

                Financial support: This work was funded by the U.S. Navy and the U.S. Department of Defense Health Agency Research, Development, Technology, and Evaluation programs under work unit number D1423.

                Authors’ addresses: Sara E. Canavati, Gerard C. Kelly, Thuan Huu Vo, and Long Khanh Tran, Vysnova Partners, Inc., Landover, MD, E-mails: saracanavati@ 123456yahoo.com , gerardckelly@ 123456gmail.com , vo.huuthuan@ 123456yahoo.com , and long.hsph@ 123456gmail.com . Thang Duc Ngo and Duong Thanh Tran, National Institute of Malariology, Parasitology and Entomology, Hanoi, Vietnam, E-mails: epinimpe@ 123456gmail.com and tranthanhduong@ 123456hotmail.com . Kimberly A. Edgel and Nicholas J. Martin, U.S. Naval Medical Research Unit TWO, Singapore, E-mails: kimberly.a.edgel.mil@ 123456mail.mil and martin.nicholas.mil@ 123456afrims.org .

                Article
                tpmd200711
                10.4269/ajtmh.20-0711
                8103484
                33819169
                5f480a30-ed1a-4733-b870-1bff94cb5a1d
                © The American Society of Tropical Medicine and Hygiene

                Open Access statement. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                History
                : 21 June 2020
                : 05 February 2021
                Page count
                Pages: 8
                Categories
                Articles

                Infectious disease & Microbiology
                Infectious disease & Microbiology

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