Graduation Year
2024
Document Type
Thesis
Degree
M.S.P.H.
Degree Name
MS in Public Health (M.S.P.H.)
Degree Granting Department
Public Health
Major Professor
Gillian Stresman, Ph.D.
Co-Major Professor
Jason Salemi, Ph.D.
Committee Member
Lucas N. Amenga-Etego, Ph.D.
Keywords
Africa, household, indoor residual spraying, insecticide-treated nets, survey
Abstract
Background. Urbanization and population movements increase urban malaria risk, necessitating adjustments to traditional control strategies. Data on vector control methods in urban African settings and their association with malaria risk remain limited.
Objectives. To evaluate the association between vector control methods and Plasmodium falciparum infection in Accra, Ghana, and how this association varies by malaria transmission season, residency, and travel history.
Methods. This observation study utilized data from two cross-sectional household surveys conducted in March-April and June-July 2024 as part of the MUSE study. Participants were household members over six months old who gave consent, randomly selected from 13 health facilities (HF) catchment areas. Exclusion criteria included conditions requiring urgent medical care. Data were collected using interviewer-administered questionnaires, and parasite DNA was detected using loop-mediated isothermal amplification assay on finger-prick blood spots. Categorical and non-normally distributed continuous variables were analyzed using chi-square and Wilcoxon rank-sum tests, respectively. A p-value of <0.05 was considered statistically significant. An interaction analysis was conducted using a two-level logistic regression model with a random intercept for household-level clustering. Prevalence odds ratios and 95% confidence intervals were calculated.
Results. Among, 6,232 participants from 2,501 households around 26 HF, P. falciparum prevalence was 7.4%, varying by season, residency, and HF (2.3-15.0%). Indoor residual spraying (IRS), used by only 11% of participants, was associated with reduced malaria odds by 53% in urban areas, 52% in non-travelers, and 37% during the first survey. Mosquito coil and spray, the most used tools, were associated with a statistically significant reduced malaria odds of 33% during the first survey. Coil use had a protective effect in peri-urban areas (26% reduction odds), while spray use reduced odds by 47% among non-travelers. Travel history significantly modified the effect of insecticide-treated net use: malaria odds were increased by 72% in travelers but reduced by 10% in non-travelers.
Conclusion. The findings highlight the need to integrate IRS into vector control campaigns in Accra and tailor strategies to seasonal and environmental contexts to maximize effectiveness. Travel is a critical effect modifier. Educating travelers and implementing early diagnosis of imported cases are crucial to reducing local transmission.
Scholar Commons Citation
Beltrame, Anna, "Evaluating How Malaria Transmission Season, Residency, and Travel History Modify the Association Between Vector Control Method Use and P. falciparum Infection in Accra, Ghana." (2024). USF Tampa Graduate Theses and Dissertations.
https://digitalcommons.usf.edu/etd/10596
