TY - JOUR
T1 - Outdoor-sleeping and other night-time activities in northern Ghana
T2 - Implications for residual transmission and malaria prevention
AU - Monroe, April
AU - Asamoah, Obed
AU - Lam, Yukyan
AU - Koenker, Hannah
AU - Psychas, Paul
AU - Lynch, Matthew
AU - Ricotta, Emily
AU - Hornston, Sureyya
AU - Berman, Amanda
AU - Harvey, Steven A.
N1 - Publisher Copyright:
© 2015 Monroe et al.; licensee Biomed Central.
PY - 2015
Y1 - 2015
N2 - Background: Despite targeted indoor residual spraying (IRS) over a six-year period and free mass distribution of long-lasting insecticide-treated nets (ITNs), malaria rates in northern Ghana remain high. Outdoor sleeping and other night-time social, cultural and economic activities that increase exposure to infective mosquito bites are possible contributors. This study was designed to document these phenomena through direct observation, and to explore the context in which they occur. Methods: During the late dry season months of February and March 2014, study team members carried out continuous household observations from dusk to dawn in one village in Ghana's Northern Region and one in Upper West Region. In-depth interviews with health workers and community residents helped supplement observational findings. Results: Study team members completed observations of 182 individuals across 24 households, 12 households per site. Between the two sites, they interviewed 14 health workers, six community health volunteers and 28 community residents. In early evening, nearly all study participants were observed to be outdoors and active. From 18.00-23.00 hours, socializing, night school, household chores, and small-scale economic activities were common. All-night funerals, held outdoors and attended by large numbers of community members, were commonly reported and observed. Outdoor sleeping was frequently documented at both study sites, with 42% of the study population sleeping outdoors at some time during the night. While interviewees mentioned bed net use as important to malaria prevention, observed use was low for both indoor and outdoor sleeping. Net access within households was 65%, but only 17% of those with access used a net at any time during the night. Participants cited heat as the primary barrier and reported higher net use during the rainy season. Discussion: Outdoor sleeping and other night-time activities were extensive, and could significantly increase malaria risk. These findings suggest that indoor-oriented control measures such as ITNs and IRS are insufficient to eliminate malaria in this setting, especially given the low net use observed. Development and evaluation of complementary outdoor control strategies should be prioritized. A research agenda is proposed to quantify the relative risk of outdoor night-time activities and test potential vector control interventions that might reduce that risk.
AB - Background: Despite targeted indoor residual spraying (IRS) over a six-year period and free mass distribution of long-lasting insecticide-treated nets (ITNs), malaria rates in northern Ghana remain high. Outdoor sleeping and other night-time social, cultural and economic activities that increase exposure to infective mosquito bites are possible contributors. This study was designed to document these phenomena through direct observation, and to explore the context in which they occur. Methods: During the late dry season months of February and March 2014, study team members carried out continuous household observations from dusk to dawn in one village in Ghana's Northern Region and one in Upper West Region. In-depth interviews with health workers and community residents helped supplement observational findings. Results: Study team members completed observations of 182 individuals across 24 households, 12 households per site. Between the two sites, they interviewed 14 health workers, six community health volunteers and 28 community residents. In early evening, nearly all study participants were observed to be outdoors and active. From 18.00-23.00 hours, socializing, night school, household chores, and small-scale economic activities were common. All-night funerals, held outdoors and attended by large numbers of community members, were commonly reported and observed. Outdoor sleeping was frequently documented at both study sites, with 42% of the study population sleeping outdoors at some time during the night. While interviewees mentioned bed net use as important to malaria prevention, observed use was low for both indoor and outdoor sleeping. Net access within households was 65%, but only 17% of those with access used a net at any time during the night. Participants cited heat as the primary barrier and reported higher net use during the rainy season. Discussion: Outdoor sleeping and other night-time activities were extensive, and could significantly increase malaria risk. These findings suggest that indoor-oriented control measures such as ITNs and IRS are insufficient to eliminate malaria in this setting, especially given the low net use observed. Development and evaluation of complementary outdoor control strategies should be prioritized. A research agenda is proposed to quantify the relative risk of outdoor night-time activities and test potential vector control interventions that might reduce that risk.
KW - Bed net access
KW - Ghana
KW - Indoor residual spraying
KW - Insecticide-treated bed nets
KW - Insecticide-treated mosquito nets
KW - Longlasting insecticidal nets
KW - Malaria
KW - Night-time observation
KW - Outdoor-sleeping
KW - Qualitative research
KW - Residual transmission
KW - West Africa
UR - http://www.scopus.com/inward/record.url?scp=84924115450&partnerID=8YFLogxK
U2 - 10.1186/s12936-015-0543-4
DO - 10.1186/s12936-015-0543-4
M3 - Article
C2 - 25627277
AN - SCOPUS:84924115450
SN - 1475-2875
VL - 14
JO - Malaria Journal
JF - Malaria Journal
IS - 1
M1 - 35
ER -