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研究生:裴敦輝
研究生(外文):Paton Guillaume Pare
論文名稱:INSECTICIDE TREATED MOSQUITO NET AND MALARIA RISK IN BURKINA FASO CHILDREN AGED UNDER 5 YEARS: Exploring Individual, Household and Area Level Effects
論文名稱(外文):INSECTICIDE TREATED MOSQUITO NET AND MALARIA RISK IN BURKINA FASO CHILDREN AGED UNDER 5 YEARS: Exploring Individual, Household and Area Level Effects
指導教授:藍祚運藍祚運引用關係
指導教授(外文):Tzuo-Yun Lan
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:國際衛生碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:英文
論文頁數:58
中文關鍵詞:guardian
外文關鍵詞:guardian
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Background: Recent evidence shows that high insecticide treated net coverage is not always associated with a reduction in malaria prevalence. Our study aims to assess the relationship between the use of ITNs and the risk of malaria infection in under five children and the role of individual, household and area level factors.
Methods: We used MIS 2014 nationally representative data to run mixed effect logistic regression models to test for a relationship between ITN use and infection risk.
Results: Among 6081 children, 2903 (47.74%) had been tested positive for malaria. Having slept under an ITN the night before the survey did not significantly reduce malaria infection risk. Older children had a higher risk of infection as well as children from poorer households, those living with 3 or more adults and those living in areas with high average monthly rainfall. Living in urban or densely populated area or in a health district with a better spatial access to health facilities were protective factors. Interestingly, the use of ITNs did provide a significant protection against malaria among richest households.
Conclusion: The combination of preventive measures is the most likely explanation for the protection offered by ITNs among children from richest households. Improving access to prevention, in particular improving sanitation and access to health services will help reduce malaria prevalence.
Background: Recent evidence shows that high insecticide treated net coverage is not always associated with a reduction in malaria prevalence. Our study aims to assess the relationship between the use of ITNs and the risk of malaria infection in under five children and the role of individual, household and area level factors.
Methods: We used MIS 2014 nationally representative data to run mixed effect logistic regression models to test for a relationship between ITN use and infection risk.
Results: Among 6081 children, 2903 (47.74%) had been tested positive for malaria. Having slept under an ITN the night before the survey did not significantly reduce malaria infection risk. Older children had a higher risk of infection as well as children from poorer households, those living with 3 or more adults and those living in areas with high average monthly rainfall. Living in urban or densely populated area or in a health district with a better spatial access to health facilities were protective factors. Interestingly, the use of ITNs did provide a significant protection against malaria among richest households.
Conclusion: The combination of preventive measures is the most likely explanation for the protection offered by ITNs among children from richest households. Improving access to prevention, in particular improving sanitation and access to health services will help reduce malaria prevalence.
Acknowledgements i
ABSTRACT ii
TABLE OF CONTENTS iv
LIST OF TABLES viii
LIST OF FIGURES viii
LIST OF ABBREVIATIONS ix
1. INTRODUCTION 1
1.1. Background 1
1.2. Literature review 5
1.3. Research objective 6
2. RESEARCH METHODS 8
2.1. The study 8
2.1.1. Country profile 8
2.1.2. Burkina Faso healthcare system 9
2.1.3. Malaria prevention activities 10
2.2. Study Population 10
2.3. Study design 11
2.4. Sampling and data collection 12
2.4.1. Inclusion criteria 14
2.4.2. Non-inclusion 14
2.5. Variables 16
2.5.1. Individual level covariates 16
2.5.2. Household level covariates 18
2.5.3. Area level covariates 20
2.6. Statistical analysis 21
2.7. Ethical considerations 24
3. RESULTS 25
3.1. Characteristics of study participants 25
3.1.1. Individual characteristics 25
3.1.2. Household characteristics 26
3.1.3. Area level characteristics 27
3.2. Individual characteristics and the risk of malaria infection 29
3.2.1. Mosquito bed net utilization and the risk of Plasmodium infection 29
3.2.2. Other individual characteristics associated with Plasmodium infection 29
3.3. Household characteristics and the risk of infection 30
3.4. Area level characteristics and the risk of infection 33
3.5. Unexplained heterogeneity 35
3.6. ITN use and wealth index 35
4. DISCUSSION 37
4.1. Characteristics of study participants 37
4.1.1. Individual characteristics 37
4.1.2. Household level characteristics 38
4.1.3. Area level characteristics 38
4.2. Individual characteristics and the risk of infection 38
4.2.1. ITN use 38
4.2.2. Age 39
4.2.3. Mother education 40
4.3. Household characteristics and risk of infection 40
4.3.1. Wealth index 40
4.3.2. Relationship structure 41
4.4. Area level characteristics and risk of infection 42
4.4.1. Type of place of residency and population density 42
4.4.2. Average monthly rainfall 43
4.4.3. Access to healthcare 43
4.5. Unexplained heterogeneity 44
4.6. ITN use and wealth index 45
4.7. Study strengths and limitations 45
5. CONCLUSION 47
6. IMPLICATIONS 48
7. References 49
APPENDIX 52

LIST OF TABLES
Table I: Distribution of individual level characteristics 23
Table II: Distribution of household characteristics 25
Table III: Distribution of area level characteristics 26
Table IV: Individual level covariates and risk of Plasmodium infection 28
Table V: Household level covariate and risk of Plasmodium infection 30
Table VI: Area level variables and the risk of Plasmodium infection 32
Table VII: Random variance, ICC and Median odd ratio 33
Table VIII: Stratified analysis of ITN use and malaria infection risk 34

LIST OF FIGURES
Figure 1: Malaria prevention strategies 4
Figure 2: Location of Burkina Faso in Africa 7
Figure 3: Conceptual framework 11
Figure 4: The sample sizes on Individual, household and area levels 14
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