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      Community-based house improvement for malaria control in southern Malawi: Stakeholder perceptions, experiences, and acceptability

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          Abstract

          House improvement (HI) refers to the full screening or closing of openings such as windows, doors, and eaves, as well as the installation of ceilings, to reduce mosquito-human contact indoors. HI is a viable supplementary intervention that reduces malaria transmission further than the existing strategies alone. In Malawi, HI has not been widely implemented and evaluated for malaria control. Concerns about lack of local evidence, durability in different epidemiological and cultural settings, and the cost of large-scale implementation are among the reasons the strategy is not utilised in many low-income countries. This study assessed community perceptions, experiences, and acceptability of community-led HI in Chikwawa district, southern Malawi. This was a qualitative study where separate focus group discussions were conducted with members from the general community (n = 3); health animators (n = 3); and HI committee members (n = 3). In-depth interviews were conducted with community members (n = 20), and key-informant interviews were conducted with health surveillance assistants and chiefs (n = 23). All interviews were transcribed and coded before performing a thematic content analysis to identify the main themes. Coded data were analysed using Nvivo 12 Plus software. Study participants had a thorough understanding of HI. Participants expressed satisfaction with HI, and they reported enabling factors to HI acceptability, such as the reduction in malaria cases in their villages and the safety and effectiveness of HI use. Participants also reported barriers to effective HI implementation, such as the unavailability and inaccessibility of some HI materials, as well as excessive heat and darkness in HI houses compared to non-HI houses. Participants indicated that they were willing to sustain the intervention but expressed the need for strategies to address barriers to ensure the effectiveness of HI. Our results showed the high knowledge and acceptability of HI by participants in the study area. Intensive and continued health education and community engagement on the significance of HI could help overcome the barriers and improve the acceptability and sustainability of the intervention.

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          Using the framework method for the analysis of qualitative data in multi-disciplinary health research

          Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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            The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015

            Since the year 2000, a concerted campaign against malaria has led to unprecedented levels of intervention coverage across sub-Saharan Africa. Understanding the effect of this control effort is vital to inform future control planning. However, the effect of malaria interventions across the varied epidemiological settings of Africa remains poorly understood owing to the absence of reliable surveillance data and the simplistic approaches underlying current disease estimates. Here we link a large database of malaria field surveys with detailed reconstructions of changing intervention coverage to directly evaluate trends from 2000 to 2015 and quantify the attributable effect of malaria disease control efforts. We found that Plasmodium falciparum infection prevalence in endemic Africa halved and the incidence of clinical disease fell by 40% between 2000 and 2015. We estimate that interventions have averted 663 (542–753 credible interval) million clinical cases since 2000. Insecticide-treated nets, the most widespread intervention, were by far the largest contributor (68% of cases averted). Although still below target levels, current malaria interventions have substantially reduced malaria disease incidence across the continent. Increasing access to these interventions, and maintaining their effectiveness in the face of insecticide and drug resistance, should form a cornerstone of post-2015 control strategies.
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              User acceptance of information technology: system characteristics, user perceptions and behavioral impacts

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: MethodologyRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Funding acquisitionRole: ResourcesRole: Writing – review & editing
                Role: ResourcesRole: SupervisionRole: Writing – review & editing
                Role: Funding acquisitionRole: ResourcesRole: SoftwareRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                14 July 2022
                2022
                : 2
                : 7
                : e0000627
                Affiliations
                [1 ] Division of Internal Medicine, Department of Infectious Diseases, Center for Tropical Medicine and Travel Medicine, University of Amsterdam, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
                [2 ] School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
                [3 ] Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
                [4 ] Centre for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
                [5 ] African Institute for Development Policy, Lilongwe, Malawi
                [6 ] Biological Sciences Department, Mzuzu University, Mzuzu, Malawi
                PLOS: Public Library of Science, UNITED STATES
                Author notes

                The authors declare that they have no competing interests.

                Author information
                https://orcid.org/0000-0001-5040-2807
                https://orcid.org/0000-0001-9501-578X
                https://orcid.org/0000-0001-8517-1586
                https://orcid.org/0000-0002-2195-6461
                https://orcid.org/0000-0002-7269-0405
                https://orcid.org/0000-0002-5087-6321
                https://orcid.org/0000-0002-1976-0726
                https://orcid.org/0000-0003-1753-2727
                https://orcid.org/0000-0001-8365-2482
                https://orcid.org/0000-0002-9983-638X
                https://orcid.org/0000-0001-8149-0897
                Article
                PGPH-D-21-01190
                10.1371/journal.pgph.0000627
                10021647
                36962454
                aebdd5d1-ef10-4a01-880c-5a3731a44f1d
                © 2022 Tizifa et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 29 December 2021
                : 23 May 2022
                Page count
                Figures: 0, Tables: 2, Pages: 21
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100010573, Stichting Dioraphte;
                The Majete Malaria Project, generously supported by the Dioraphte Foundation (the Netherlands) through The University of Amsterdam, University Medical Centers funded this PhD research. The content is solely the authors' responsibility and does not necessarily represent the official views of the funders. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Medical Conditions
                Parasitic Diseases
                Malaria
                Medicine and Health Sciences
                Medical Conditions
                Tropical Diseases
                Malaria
                Earth Sciences
                Geography
                Human Geography
                Social Geography
                Social Sciences
                Human Geography
                Social Geography
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Disease Vectors
                Insect Vectors
                Mosquitoes
                Biology and Life Sciences
                Species Interactions
                Disease Vectors
                Insect Vectors
                Mosquitoes
                Biology and Life Sciences
                Zoology
                Entomology
                Insects
                Mosquitoes
                Biology and Life Sciences
                Organisms
                Eukaryota
                Animals
                Invertebrates
                Arthropoda
                Insects
                Mosquitoes
                Biology and Life Sciences
                Zoology
                Animals
                Invertebrates
                Arthropoda
                Insects
                Mosquitoes
                People and Places
                Geographical Locations
                Africa
                Malawi
                Research and Analysis Methods
                Research Design
                Qualitative Studies
                Biology and Life Sciences
                Zoology
                Entomology
                Insects
                Termites
                Biology and Life Sciences
                Organisms
                Eukaryota
                Animals
                Invertebrates
                Arthropoda
                Insects
                Termites
                Biology and Life Sciences
                Zoology
                Animals
                Invertebrates
                Arthropoda
                Insects
                Termites
                Earth Sciences
                Geography
                Human Geography
                Housing
                Social Sciences
                Human Geography
                Housing
                Ecology and Environmental Sciences
                Sustainability Science
                Custom metadata
                The datasets used and analyzed during the current study are available within the manuscript and as supplementary files.

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