The Role of Bed Net Usage and Lymphatic Filariasis Transmission in Kenya Pubblico

Abstract

Background: Mass Drug Administration (MDA) has been the main strategy used for the elimination of lymphatic filariasis (LF) and is conducted annually in endemic areas. However, current research supports that bed net usage can prevent transmission of LF even after a lapse of MDA implementation. This study examines LF infection rates in Kenya after a lapse of MDA and compares the infection rates with bed net usage rates in ten villages from five implementation units (IUs) in coastal Kenya where LF is endemic, thereby assessing the impact of bed net usage during the absence of MDA.

Methods: The Kenya Medical Research Institute (KEMRI) conducted cross-sectional surveys in five counties (IUs) using ten sentinel sites (ten villages) as the units of analysis. LF prevalence was determined using a rapid antigen test known as immunochromatographic card test (ICT) which detects Wuchereria bancrofti infections. A bed net usage questionnaire was administered, and participants' responses were captured electronically using Open Data Kit for android-based smartphones.

Key Findings: The study population was 2,996 comprised of 1,392 children under the age of 15 and 1,604 adults between the age of 16 and 100. LF prevalence of 1.18% was found in the combined population examined in the five implementation units (IUs), which is considered significant. The highest LF prevalence of 6.25% was found in Lamu County, and the second highest prevalence of 0.88% was found in Kilifi County. The lowest bed net usage was in the villages of Ndau at 74.38% and Mwadimu at 74.83%, and these two villages had the highest LF infection rates.

Conclusion: The study showed evidence that bed net usage plays a significant role in the reduction of LF transmission. Usage of bed nets as a vector control method has been shown to be effective in the control and elimination of LF transmission. This augmentative vector control is an alternative where MDAs are not always possible or have lapsed. Nets are still efficacious and necessary, even where MDAs are possible. It is therefore critical to have vector control management strategies in place that ensure the integration of MDA and augmentative vector control. Integration of MDAs and vector control strategies such as bed net usage will ensure long-term elimination goals and make the 2020 LF elimination target date a reality.

Table of Contents

ABSTRACT.................................................................................................................................4

LIST OF ACRONYMS AND DEFINITION OF TERMS.......................................................................6

CHAPTER 1: INTRODUCTION....................................................................................................10

The Purpose of this Research.....................................................................................................10

Problem Statement...................................................................................................................11

Theoretical Framework.............................................................................................................14

Purpose Statement...................................................................................................................15

Research Hypothesis ................................................................................................................15

Research Questions:.................................................................................................................15

Conclusion:..............................................................................................................................16

CHAPTER 2: BACKGROUND AND LITERATURE REVIEW .............................................................17

Lymphatic Filariasis and Its Transmission...................................................................................17

Science of Lymphatic Filariasis ..................................................................................................19

Lymphatic Filariasis in Kenya.....................................................................................................21

Evidence of Bed Net Usage and LF Control..................................................................................22

Conclusion ...............................................................................................................................25

CHAPTER 3: METHODS.............................................................................................................26

Introduction.............................................................................................................................26

Study Area................................................................................................................................26

Study Design.............................................................................................................................28

Ethical Consideration.................................................................................................................28

Study population.......................................................................................................................29

Data Collection and Survey Questions.........................................................................................29

Data Analysis............................................................................................................................31

CHAPTER 4. RESULTS ...............................................................................................................32

Prevalence by Village.................................................................................................................32

Bed Net Usage by County............................................................................................................33

Infection Rates by Age................................................................................................................35

Bed Net Usage by Age.................................................................................................................37

Usage by Gender.........................................................................................................................38

Infection by Gender.....................................................................................................................39

Bed Net Usage by Household Size.................................................................................................41

Conclusion .................................................................................................................................43

CHAPTER 5: DISCUSSION...........................................................................................................44

Introduction...............................................................................................................................44

Summary of Findings..................................................................................................................44

Limitations.................................................................................................................................46

Implications................................................................................................................................47

Recommendations.......................................................................................................................47

REFERENCES..............................................................................................................................51

APPENDICES..............................................................................................................................54

List of Figures:

Figure 1. LF Elimination Status in Kenya (GAHI, 2010)...................................................................13

Figure 2. Life Cycle of Wuchereria Bancrofti..................................................................................20

Figure 3. Map of Kenya showing the counties under study..............................................................27

Figure 4: ICT Card......................................................................................................................30

Figure 5. LF Prevalence by Village................................................................................................33

Figure 6. Bed Net Usage by County...............................................................................................34

Figure 7. Bed Net Usage by Village...............................................................................................35

Figure 8. LF Infection by Age.......................................................................................................37

Figure 9. Bed Net Usage by Age...................................................................................................38

Figure 10. LF Infection by Gender................................................................................................39

Figure 11. Gender Representation by Village................................................................................40

Figure 12. Bed Net Usage by Household Size.................................................................................42

Figure 13. Bed Net Usage and LF Prevalence by Village..................................................................43

List of Tables:

Table 1. Core Constructs of the Health Belief Model (adapted from the Dept. of Health and Human Services, e-Source)...15

Table 2. Study Implementation Units and Sentinel Sites................................................................28

Table 3. LF Prevalence by County.................................................................................................32

Table 4. LF Infection Rates by Age Group......................................................................................36

Table 5. Breakdown of Bed Net Usage by Gender...........................................................................38

Table 6. Female LF Infections by Village.......................................................................................40

Table 7. Male LF Infections by Village...........................................................................................41

List of Appendices:

Appendix 1. KEMRI LF Survey Questionnaire................................................................................54

Appendix 2. KEMRI IRB.. 56 .......................................................................................................56

Appendix 3. Emory IRB Exemption. 57 ........................................................................................57

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General
Parola chiave	Neglected Tropical Diseases (NTDs) Bed Nets Lymphatic Filariasis
Committee Chair / Thesis Advisor	Miner, Kathleen R, Emory University
Committee Members	Njenga, Sammy, KEMRI
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti)

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