Research Articles

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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community

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    Detecting permethrin on treated bed nets [2]
    (1994) Muller, O.; Quinones, M.; Cham, K.; Aikins, M.; Greenwood, B.
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    Geographical perspectives on bednet use and malaria transmission in the Gambia, West Africa
    (1996-07) Thomson, M.; Connor, S.; Bennett, S.; D'Alessandro, U.; Milligan, P.; Aikins, M.; Langerock, P.; Jawara, M.; Greenwood, B.
    Insecticide-impregnated bednets are now widely accepted as an important tool in reducing malaria-related deaths in children in Africa. Defining the circumstances in which net treatment programmes are likely to be effective is essential to a rational development of this control strategy. In The Gambia a National Impregnated Bednet Programme was introduced into the primary health care system in 1992. Prior to its introduction baseline epidemiological and entomological studies were conducted throughout the country. These studies showed that in areas where mosquito biting nuisance was high, people protected themselves with bednets and that where mosquito densities (and therefore bednet usage) was low malaria prevalence rates were relatively high. Since the national programme is designed to assist only those people who already own a bednet (by providing the insecticide) an understanding of the factors which determine bednet ownership is needed to help evaluate the programme's effectiveness and provide guidelines for increasing bednet usage. Village scale bednet usage rates and malaria prevalence rates obtained from the baseline survey were correlated with certain geographical variables: dominant ethnic group, area, habitat, distance from the River Gambia and distance from the 'bluffline' (the interface between the sandstone soils and alluvial soils which border the river system). In a multiple regression analysis, bednet usage was independently associated with area (P < 0.001), ethnic group (P = 0.010), habitat (P = 0.006) and distance from the river (P = 0.013). A negative association of bednet usage with malaria prevalence persisted after allowing for the other variables. Malaria prevalence was not independently associated with area, ethnic group, habitat or distance from the river. Our analysis showed that the impregnated bednet programme is likely to be most effective in villages which are sited near to or on the alluvial soils in the middle and lower river zones. These villages, which were originally settled for easy access to the river (for transport) and its swampy margins (for rice production) are within the flight distance of mosquitoes that have their breeding sites on the poorly drained alluvial soils. Variation in malaria prevalence rates (after bednet usage has been taken into account) may be related to factors such as poverty and access to health care, and/or to localized differences in the ecology of The Gambia, which determine the duration and intensity of transmission. If the National Bednet Programme is to be effective throughout The Gambia it is vital to develop promotional activities which will encourage bednet usage in areas where nuisance biting by mosquitoes is low.
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    Financing mechanisms for village activities in the gambia and their implications for financing insecticide for bednet impregnation
    (1994-12) Mills, A.; Fox-Rushby, J.; Aikins, M.; D'Alessandro, U.; Cham, K.; Greenwood, B.
    The recent enthusiasm for impregnated bednets as a malaria control measure leaves unresolved the question of how to finance them. The National Impregnated Bednet Programme in The Gambia faced the question of how to obtain funds from villages to finance the cost of insecticide, but knew very little about current village fundraising for development purposes. A survey was conducted of such fundraising, and questions also asked about willingness to pay for insecticide and preferred means of paying. All 53 villages surveyed paid taxes/rates, but 34% of villages reported no voluntary fundraising. The most common reason for collecting money was for the maintenance of wells (40% of villages). Collective farming was used as a means of raising money in 32% of villages. There was some variation in the type and extent of fundraising by region and also by the predominant ethnic groups of the village. Villages with voluntary fundraising activities seemed to have well established collective mechanisms for agreeing on sums to be collected and their use, and for collecting and recording income and expenditure. Non-payment was rare, and misuse of funds was not reported. Respondents were asked how much compounds might be willing to pay for insecticide impregnantion: the most frequently cited maximum amounts were D5 and 10, and minimum D1 and 5 (D15 = 1 pound). The paper discusses payment options for insecticide, such as whether the village should be allowed to decide itself how to raise funds, and whether the payment should be made only by households with nets or by a village-wide mechanism such as collective farming.(ABSTRACT TRUNCATED AT 250 WORDS) PIP: Surveys were conducted in 53 villages in The Gambia to determine the status of current village fundraising for development purposes. Questions were also asked about respondents' willingness to pay for insecticide and the preferred means of paying. All of the surveyed villages paid taxes/rates, but 34% of villages reported no voluntary fundraising. The most common reason for collecting money was for the maintenance of wells; such fundraising was cited by 40% of villages. Collective farming was used as a means of raising money in 32% of villages. The authors identified some variation in the type and extent of fundraising by region and also by the predominant ethnic groups of the village. Villages with voluntary fundraising activities seemed to have well established collective mechanisms for agreeing upon sums to be collected and their use, and for collecting and recording income and expenditure. Non-payment was rare and the misuse of funds was not reported. Respondents most frequently cited a compound willingness to pay a maximum of D5-10 for insecticide impregnation, with D15 equivalent to one pound Sterling. Payment options for insecticide are discussed, followed by the presentation of details of the actual mechanism selected for implementation by the National Impregnated Bednet Program
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    Nationwide survey of bednet use in rural Gambia
    (1994) D'Alessandro, U.; Aikins, M.; Langerock, P; Bennett, S.; Greenwood, B.M.
    A nationwide survey was carried out to investigate the use of bednets in rural areas of the Gambia, particularly among children under 5 years old and among pregnant women. A stratified multistage design was used; 360 compounds in 60 villages were visited. Overall, 58% of beds had a net, with very little difference between villages with primary health care (PHC) facilities and those without (non-PHC). Bednet use was higher in the Central Region (76%) than in the Western and Eastern Regions (both 51%). It was highest among the Jola ethnic group (77%) and lowest among Sarahulis and other minority groups. Use of bednets was higher among target groups (such as infants, children under 5 years old, and pregnant women) than among the general population, and reached a level of over 90% in these groups in the Central Region. Use was associated with possession of a metal bed and a radio. Previous trials of impregnated bednets in the Gambia have been carried out in the Central Region, where bednet use is highest. The efforts of the National Impregnated Bednet Programme should therefore concentrate on the other regions and among the minority ethnic groups in order to increase bednet ownership.
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    The impact of charging for insecticide on the Gambian national impregnated bednetprogramme
    (1997-09) Cham, M.K.; Olaleye, B.; D'Alessandro, U.; Aikins, M.; Cham, B.; Maine, N.; Williams, L.A.; Mills, A.; Greenwood, B.M.
    During the second year of the Gambian National Impregnated Bednet Programme (NIBP) charges for insecticide ($0.50 per net) were introduced into the half of the primary health care villages in the country where insecticide have been provided free of charge the previous year. Free insecticide was provided in the remaining villages that had acted as controls during the previous year. In villages where insecticide was provided free, 77% of nets were treated with insecticide. In contrast, in villages where charges were made coverage was only 14%. During the first year of the NIBP, mortality in children was significantly lower in villages where insecticide was provided free than in the control villages. Introduction of a charge for insecticide into the first group of villages and the provision of free insecticide in the latter abolished this difference. The cash income of rural Gambians is very limited and payment of even $2-3 for insecticide treatment for all the bednets in a household represents a substantial outlay. Further education on the benefits of treatment of nets and/or the provision of cheaper insecticide will be required before the full benefits of this powerful new malaria control measure can be fully realised in the Gambia. PIP: Insecticide for the treatment of bednets was provided free of charge to half of Gambia's primary health care (PHC) villages during the first year of the Gambian National Impregnated Bednet Program (NIBP). A high level of coverage was obtained and overall mortality among children aged 1-9 years was reduced 25% in villages where insecticide was provided. During the second year of the program, charges for insecticide of $0.50 per net were introduced to the 221 PHC villages which had previously received free insecticide, while the remaining PHC villages received free insecticide. In villages where insecticide was provided free during year 2, 77% of nets were treated with insecticide, far higher than the 14% coverage achieved in villages where fees were charged. During the first year of the NIBP, mortality in children was significantly lower in villages where insecticide was provided free compared to that in the control villages. Introducing a charge for insecticide in the first group of villages and providing free insecticide in the latter abolished that difference. Additional education on the benefits of net treatment and/or the provision of cheaper insecticide will be needed before the full benefits of net treatment can be fully realized in the Gambia.