Background:Malaria remains a major public health and economic burden, especially in sub-Saharan Africa, which accounted for an estimated 94% of the 263 million global malaria cases and 597,000 deaths reported in 2023. In Tanzania, malaria prevalence is estimated at 8%, however regional disparities exist. Mtwara Region reported highest prevalence at 20% in 2022, increasing from 15% in 2017, despite the region's goal to eliminate malaria by 2030. Tandahimba district, in particular, has persistent high transmission despite ongoing control interventions, raising concerns about underlying environmental and socio-cultural factors to malaria transmission. This study aimed to determine the prevalence, environmental and socio-cultural influences linked with malaria cases in the Tandahimba District Council. Materials and Methods:A mixed-method study using a convergent parallel design was conducted. A multi-stage cluster sampling method was used to select 522 participants. Quantitative data were collected from these participants using structured questionnaires, while qualitative data were obtained through in-depth interviews with Ward Executive Officers and the District Vector Control Officer. Quantitative data were analysed using Stata version 17, applying a modified Poisson regression model to estimate adjusted prevalence ratios (aPRs) with 95% confidence intervals (CIs). Variables with p ≤ 0.05 were considered significant. Qualitative data were analysed thematically using NVivo and integrated with quantitative results to provide a comprehensive understanding. Results:Among the 522 participants, the mean age was 41 years (±22.5 SD). Maundo ward contributed the highest proportion of participants (24.1%). Environmental factors significantly associated with malaria included earth mud/grass wall materials (aPR = 1.47, 95%CI: 1.19-1.82, p < 0.001) and open eaves (aPR = 1.46, 95%CI: 1.23-1.73, p < 0.001), while metal sheet roofing was protective (aPR = 0.77, 95%CI: 0.69-0.86, p < 0.001). Socio-cultural factors such as travel history (aPR = 1.28, 95%CI: 1.07-1.53, p = 0.006) and staying outdoors at night (aPR = 1.29, 95%CI: 1.09-1.53, p = 0.003) increased malaria risk. Protective factors included bednet use, mosquito repellents, and mosquito sprays. Conclusions:Malaria prevalence in Tandahimba District is strongly influenced by environmental housing conditions and socio-cultural behaviours. Integrated, community-led interventions addressing housing improvements and preventive practices are essential for effective malaria control.
Background:Malaria remains a significant public health challenge in Nigeria, especially among children under five years. The recent introduction of WHO-recommended malaria vaccines offers renewed hope for reducing malaria-related morbidity and mortality, but caregivers' willingness to vaccinate their children depends on their awareness, perceptions and practices. Guided by the Health Belief Model (HBM), this study investigated caregivers' willingness to vaccinate their children against malaria and the factors associated with this willingness in the Akoko area of Ondo State, Nigeria. Materials and Methods:A community-based cross-sectional study was conducted among 498 caregivers of children aged 0-59 months across eight rural and semi-urban communities in Akoko, selected using a multi-stage sampling technique. Data were collected using a structured, pre-tested questionnaire alongside malaria testing using rapid diagnostic test (RDT) kits, and analysed with Microsoft Excel and R software using descriptive and inferential statistics, including multivariable logistic regression. Results:The mean age (± SD) of caregivers was 34.5±11.0 years, and most were female (87.1%). Most caregivers reported appropriate malaria preventive practices, particularly mosquito net ownership, use of insecticide-treated nets, and environmental sanitation; preventive practice was significantly associated with caregiver education (p < 0.05). Malaria prevalence among under-five children was 10.1% and varied significantly with age (p = 0.008). Awareness of the malaria vaccine was high (77.9%), predominantly sourced from the health system, and willingness to vaccinate was high (87.9%). The mean overall HBM score was 48.3±13.9 (out of 60). Willingness to vaccinate was significantly associated with religion, trust in vaccine information and HBM category (p = 0.014, p = 0.002, p < 0.001, respectively). In multivariable analysis, caregivers who did not trust the information they received (AOR = 0.16; 95% CI: 0.05-0.53; p = 0.002) and those whose previous vaccination experiences influenced their decision (AOR = 0.24; 95% CI: 0.09-0.71; p = 0.009) had lower odds of willingness to vaccinate, while a higher HBM score was associated with higher odds of willingness (AOR = 1.04; 95% CI: 1.00-1.08; p = 0.030). Conclusions:Malaria preventive practices and health beliefs were generally favourable in this population, and this may have contributed to the relatively low malaria prevalence observed. Trust in health information and positive health beliefs were the factors most strongly associated with caregivers' willingness to vaccinate their children. Strengthening healthcare-worker engagement, improving vaccine communication, and addressing caregivers' informational gaps are recommended to support effective and equitable malaria vaccine uptake.
Background:Chlorfenapyr-based indoor residual spraying (IRS) has been prequalified for malaria control. Residual efficacy (mosquito mortality) of IRS applied to houses is typically assessed using forced-contact cone bioassays. However, chlorfenapyr is a pro-insecticide that requires mosquito metabolic activity for conversion to its toxic metabolite, tralopyril. Cone bioassays consistently underestimate mortality compared to free-flying bioassays. This study evaluated whether increasing mosquito activity during cone bioassays could better capture chlorfenapyr-induced mortality on mud surface using scalable methods. Materials and Methods:The bioefficacy of chlorfenapyr (Sylando® 240 SC) sprayed on mud surfaces was assessed in two experiments using cone bioassays against sugar-fed, laboratory-reared pyrethroid-resistant Anopheles arabiensis and An. funestus. Experiment 1 evaluated six exposure scenarios varying cone contact time (30 vs. 120 min) and post-exposure activity using clean CDC bottles (none, 1-hr vs. 12-hrs). Experiment 2 assessed the interaction between exposure duration (30-min vs. 12-hrs) and the presence or absence of a host (rabbit). Delayed mortality was monitored up to 120 hrs. An indicative mortality threshold was estimated using a random-effect meta-analysis of three free-flying semi-field studies. Results:Mortality remained low across all treatments in experiment 1 (7.8-15.4% at 72 hrs; 14.1-23.1% at 120 hrs), with no consistent improvement from post-exposure activity. In Experiment 2, mortality increased with 12-hrs exposure, particularly in the presence of a host (23.5% at 72 hrs; OR 2.25, 95% CI 1.71-2.97, p < 0.001). However, mortality remained well below the indicative value (52%). Conclusions:Prolonged exposure and host presence modestly increased mortality, but did not produce values consistent with expected chlorfenapyr bioefficacy against free-flying mosquitoes. These findings suggest that modified cone bioassays are unlikely to provide reliable estimates of chlorfenapyr-IRS performance. Further validation is required to assess whether overnight cone tests in people's homes can provide a more realistic measure of residual bioefficacy.
Background:Globally, malaria cases increased from 228 million in 2018 to 282 million in 2024, with the African region accounting for 95% of the cases. Nigeria bears the highest malaria burden in the world, and pregnant women carry a significant number of the cases. Malaria in pregnancy (MiP) may have negative implications for maternal and neonatal health. The WHO-recommended intermittent preventive treatment using sulphadoxine-pyrimethamine (IPTp-SP) helps to prevent MiP, but its uptake is low in Nigeria. Using the theory of reasoned action (TRA), this study investigated the attitudes and intentions of pregnant women in Bayelsa State towards the use of IPTp-SP. Methods:The study adopted qualitative methods, including focus group discussions with pregnant women and key informant interviews with relevant community stakeholders. Six focus group discussions and seventeen key informant interviews were conducted with pregnant women and stakeholders, respectively. Data were managed using NVivo (version 12) and analysed thematically and deductively in line with the TRA. Results:Pregnant women had limited knowledge of preventing MiP and specifically IPTp-SP use. This resulted in a negative attitude towards the preventive technique. Interestingly, while the role of significant others, such as traditional birth attendants (TBAs), husbands and mothers-in-law, was acknowledged, many pregnant women did not succumb to the social pressure to use IPTp-SP when they did not think it was best for them. Many women intended to use IPTp-SP but had not done so at the time of the study due to structural barriers, poor access to facilities, and the unavailability of IPTp-SP. Conclusions:The use of IPTp-SP is poor among pregnant women in the sample. These women have their own will and are not necessarily pressured by social norms. Intentions may not translate to actual practice or use if structural barriers are not eliminated.
Funding and organisational barriers between Aedes and Anopheles hamstring vector control adaptation to this new era of climate change and restricted public funding. Aedes-borne diseases never got the attention or funding like malaria and are now exploding across Asia and the Americas with devastating economic impact. Malaria elimination progress has stalled, and in several contexts reversed, due to sudden donor funding restrictions. There are both tactical and strategic ways the two vector control efforts can work together to meet these challenges. Tactically, these include insecticide resistance management, residual spraying, technology for larval source management, spatial emanators and surveillance. Strategically, community engagement, urbanisation and climate change, and financing/private sector engagement. Malaria and Aedes-borne diseases have separate support networks and 'communities of practice'. Now is the time to recognise mutual tactical and strategic benefits, break down the artificial barriers between these two worlds, and face our common challenges together.
