Household Predictors of Incidence of Malaria in Northern Uganda: Its Implication for Future Malaria Control
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Date
2020
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
Use of indoor residual spraying (IRS), long-lasting insecticidal nets (LLINS) and treatment
with artemisinin-based combination therapy (ACT) have been greatly promoted in northern Uganda but
the region still records highest number of malaria cases with prevalence up to 63%. This study assesses
household predicators of malaria in the region and its impact on incidence of malaria at household
levels.
Methods: A cross-sectional study was conducted in four districts of Gulu, Oyam, Kitgum and Agago
covering sixteen known hyper-endemics villages with high malaria burden in northern Uganda. In total,
193 households were surveyed. Data was collected through pre-tested structured questionnaires and
systematically coded and analyzed using R software.
Results:
Women headed 58% of the 193 households surveyed. Six hundred and five (605) individuals were
declared to have spent a night in the 193 households surveyed. Nighttime is when mosquitoes mostly
gain access to victims in the study area. On average, there were two bed nets per household and out of
the 605 individuals declared, 502 502 (86%) spent the night prior to interview under a bed net. Despite this
effort, these households still reported malaria incidences in the last three months. Overall, children were
prone to malaria more than adults by a ratio of 3:2, and in general, malaria incidences were strongly
related to lack of bed nets or use thereof, and also linked directly to the number of individuals in a house.
Households without bed nets controlled malaria by means of IRS in combination with closing doors (with
the hope of keeping mosquitos at bay), draining stagnant water pool where mosquitos lay their eggs,
trimming mosquito covers (grass) around homestead and/or receiving treatment after malaria
incidences. When given a choice between insecticides (IRS) and treated bed nets, 1 in 3 households
preferred treated bed nets. At the same time, bed nets were perceived unnecessary once IRS was applied.
If true, the driving force to spraying insecticides indoor then becomes lack of a bed net.
Conclusions:
Household predicators of incidence of malaria in northern Uganda includes bed nets, use of treated bed
nets, and indoor residual spraying with households not practicing any of these bearing the heaviest
burden of malaria. Hierarchical clustering on principal components (HCPC) clusters households into four
types in northern Uganda, 1) household that use bed nets and sleep in houses sprayed with insecticides;
2) households that use bed nets but no indoor residual spraying with insecticides; 3) households that
have no bed nets and no indoor residual spraying; and 4) test bed nets before use. An opportunity
therefore arises for tailoring malaria messages to fit each cluster of households given that clustering here
appears not to be random. Malaria incidence was higher in children as compared to the adults that
necessities having guidelines for management of interventions in local community setting.
Description
Keywords
Predicators, Malaria, Indoor residual spraying, Long-lasting insecticidal nets Uganda
Citation
Echodu, R., Oyet, W. S., Iwiru, T., Apili, F., Lutwama, J. J., Opiyo, E. A., & Otim, O. (2020). Household Predictors of Incidence of Malaria in Northern Uganda: Its Implication for Future Malaria Control. https://doi.org/10.21203/rs.3.rs-74137/v1