Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.
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Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.
Published Version (Please cite this version)
O'Meara, Wendy Prudhomme, Nathan Smith, Emmanuel Ekal, Donald Cole and Samson Ndege (2011). Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya. PLoS One, 6(10). p. e25949. 10.1371/journal.pone.0025949 Retrieved from https://hdl.handle.net/10161/5957.
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Dr. Wendy O’Meara is an Associate Professor at Duke University School of Medicine in the Division of Infectious Diseases, visiting professor at Moi University, and the Associate Director for Research of the Duke Global Health Institute. She has been based full-time in Kenya since 2007.
Dr. O’Meara’s team is interested in improving rational drug use for suspected malaria fevers through expanding the use of diagnostic tools in the community and in health facilities. As many as 90% of fevers that seek treatment in the formal sector receive antimalarials, and it is estimated that only 20% of those buying antimalarials over-the-counter in the retail sector actually have malaria. Such overuse poses a significant threat to the continued efficacy of first-line antimalarials. Dr. O’Meara has conducted several randomized controlled trials in western Kenya to test interventions designed to improve the use of information from malaria diagnostic testing in order to target antimalarials to those with confirmed infection. In 2005, she helped to establish the Malaria Diagnostic Centre of Excellence in Kisumu, Kenya.
Dr. O’Meara is also working towards elucidating malaria transmission networks by identifying individual human-to-mosquito and mosquito-human transmission events through leveraging variability in key parasite genes (collaboration with Steve Taylor’s lab). By tracking generations of infections from humans to mosquitoes, a clearer understanding of the reservoir of infection will be possible and interventions such as ivermectin and transmission blocking vaccines can be targeted to maximizes their effectiveness.
Dr. O’Meara also has experience in marrying innovative spatial techniques with epidemiologic outcomes. Recent work includes an analysis of health systems factors that contribute to early childhood mortality in sub-Saharan Africa and the impact of malaria prevention on birth outcomes.
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