TOPIC: PREVALENCE AND MODULATING FACTORS IN THE USE OF INSECTICIDE-TREATED NETS AMONG PREGNANT WOMEN LIVING WITH HIV IN SIAYA COUNTY, KENYA
CHAPTER ONE: INTRODUCTION
- Background
Malaria is one of the critical public health issues that are faced by the world, especially in the African region, where it accounts for a huge number of cases in public health. At the same time, the scourge of HIV/AIDS remains a burden that is unmatchable, with sub-Saharan Africa having about 70% of the global HIV burden. Indeed, the synergism between malaria and human immunodeficiency virus HIV/AIDS is evident with the occurrences of the two afflictions killing more than two million people every year, as highlighted by several previous researches (World Health Organization, 2022). In 2007, there were combined deaths of more than 3 million for these two diseases alone. The high level of burden of HIV/AIDS in Africa, Kenya included, is a reality, as HIV infects an estimated 1.5 million Kenyans. Women, in particular, are at a higher risk of HIV infection, with the senior HIV prevalence among women being higher than among men. HIV / AIDS kills approximately 29% of all adults annually in Kenya, and it is part of what causes 20% of all maternal deaths in the country (World Health Organization, 2022). The HIV/AIDS pandemic poses a challenge to Siaya County, a region in Kenya that has for years contributed approximately 8% to the national total prevalence of the disease.
Furthermore, malaria is also a problem across the globe as 3 billion people are at risk, especially in Sub-Saharan Africa, where the burden of the disease is highest. According to the estimates of WHO in 2016, the region recorded 88% of global malaria cases and also accounted for about 90% of malaria deaths. Kenya suffers from malaria as another leading cause of the health burden and mortality rates, with over 70% of the population being at risk (WHO, 2023). In the regions of Lake Victoria and the coastal zones, there are increased risks, pregnant women and children under five are the most vulnerable population target. The malaria incidence is higher close to the Lam Victoria reservoir because of the higher prevalence of malaria parasites in these areas. Furthermore, beach communities are vulnerable in high-risk areas like other areas (Okoyo et al., 2021). More to this, counties around Lake Victoria show the highest prevalence rates of HIV/AIDS in Kenya.
Pregnant women who have HIV/AIDS in Kenya’s beach communities thus have the challenge of being impacted by two diseases at once, which makes it hard to have good maternal and fetal health. The malaria burden among HIV women increases by 10% during the first pregnancy. It is much higher during subsequent pregnancies because the HIV infection compromises the pregnancy-specific immunity to malaria (CDC, 2020). This co-infection, however, contributes to women’s high risk of HIV transmission, especially among young and first-time-pregnant women. The latest research suggests that malaria-infected HIV-positive pregnant women are strongly associated with low-birth-weight newborns, who themselves are at a much greater risk of mother-to-child HIV transmission than normal-weight children. This is, therefore, a high risk for HIV-positive pregnant women in Lake Rthe region with all effects of dual infection (Zulaika et al., 2021). This, despite the availability of the risks and existing gaps in knowledge regarding the use of Insecticide-Treated Nets (ITNs), recommended by WHO, is a possible strategy for mitigating the effects of malaria in pregnancy.
Although numerous studies touched upon how the ITNs uITNe occurred among pregnant women in general, very little attention was given to how the ITNs uITNe occurred among pregnant mothers living with HIV regarding malaria prevention (Gizachew Ambaw Kassie et al., 2023). Therefore, this study is designed to provide information on ITN utilization, as well as its associated factors, among the HIV/AIDS-infected expectant women living in a malaria-endemic area where the HIV/AIDS burden is also high in Siaya County. The objectives will be to determine the use levels, assess people’s knowledge about HIV and malaria co-infections, and identify the reasons that affect the use of ITNs among this vulnerable group (Tesfaye et al., 2022). The findings of this study will guide the formulation of goal-directed measures that will be aimed at decreasing the incidence of malaria-HIV co-infection among pregnant women from malaria-endemic areas at higher risk of these two infections.
1.2 Problem Statement
Of simultaneous occurrences of HIV and malaria during pregnancy, both the mother and the newborn face serious health risks. Mother and child are the most vulnerable group to malaria, with fetal malaria alone having life-threatening consequences for both the child and the mother. In addition, people with HIV infection have a higher rate of developing forms of malaria, such as severe malaria and complications (Felman, 2019). The data from various studies note that there is a greater chance of women with HIV demonstrating the signs and symptoms of malaria as compared to their counterparts who are HIV-negative. The co-infection of malaria with HIV has been reported with poor maternal, perinatal, and infant outcomes. Furthermore, this study supports the fact that near the coastal communities of Western Kenya, where HIV prevalence is high, there is a higher risk of malaria as well. The position of the World Health Organization (WHO) recommending the use of Long-Lasting Insecticidal Nets (LLINs) in the mitigation of malaria in pregnancy is common knowledge; however, many have very little or no understanding regarding their use among pregnant HIV-positive women in these vulnerable communities (Okoroafor & Christmas, 2023). Little research has been done to target the study sample to the general population. Consequently, data are scarce for the use of LLITN by HIV-positive women who are prioritized in the study.
1.3 Justification of the Study
Women in pregnancy, especially those living along the shore of Lake Victoria, have a much higher risk of acquiring malaria due to the favorable mosquito breeding conditions in the area. The supply of ITNs is the most important strategy to be implemented by the government to keep women and children from facing malaria (Byabagambi et al., 2023). Many studies have been conducted on the use of ITNS by pregnant women. However, malaria prevention awareness among HIV-positive pregnant mothers is still a big research gap. This is because the risk of malaria and HIV infection among such women is greatly elevated. Therefore, actions should be taken to address women’s ignorance regarding the utilization of ITNs during pregnancy (Duguma et al., 2022). This study aims to address the gap by researching the type of adoption and the factors influencing the use of ITNs by targeting these vulnerable population groups. Group findings will be used to develop focused control intervention plans towards reducing the effect of malaria-HIV co-infection in pregnancy in areas of high malaria endemicity with increased risk of co-infection (Maniga et al., 2022). Hence, our objective is to interrupt malaria among HIV in HIV-infected women, which has been identified as a critical public health concern, priorly.
The research will be done at Lake Victoria beaches in Bondo sub-county Siaya County, which is found to be a malaria vector area and is also considered a malaria-stable lake endemic zone. Based on the Kenya Malaria Indicator Survey (KMIS) for 2015, malaria rates remain high in these endemic lake zone areas (Alegana et al., 2021). In addition, HIV status is higher in Siaya County, and beach communities, in particular, are at a much higher risk of being infected with HIV. Among the total of 11,023 people who are living with HIV (PLHIV) in Siaya County, the number of women constitutes 60.2% of the total population, and PLHIV is 4.2 times higher than the national rate (Odhiambo et al., 2023). The county of Siaya is ranked fourth position in the number of people living with HIV, which contributes to about 8.3% of the national total.
1.4 Research Questions
- What is the level of knowledge among pregnant HIV-positive women on the dangers malaria poses to them?
- What is the prevalence of utilization of ITNs among pregnant HIV-positive women seeking services in selected health facilities in Bondo Sub County?
- What are the factors that affect the utilization of ITNs among pregnant HIV-positive women seeking services at selected health facilities in Bondo Sub County?
- What factors are associated with the study participants’ prevalence and use of ITNs?
1.5 Study hypothesis
1.5.1 Null hypothesis
HO1: There is no significant association between the level of awareness among pregnant women living with HIV and the dangers of malaria.
HO2: There is no significant association between the prevalence of utilization of ITNs and acquiring malaria among pregnant HIV-positive women.
HO3: There is no significant association between factors affecting the utilization of ITNs and acquiring malaria among pregnant women living with HIV.
HO4: There is no significant association between the prevalence and use of ITNS among study participants in the study area.
1.6 Objectives
1.6.1 Broad Objective
To investigate the prevalence and modulating factors in the use of insecticide-treated nets among pregnant women living with HIV in Bondo Sub County, Siaya County.
1.6.2 Specific objectives
- To assess the knowledge of the dangers of malaria to HIV-positive women during pregnancy in Bondo Sub County
- To determine the prevalence of utilization of ITNs among pregnant HIV-positive women in Bondo Sub County
- To identify the factors associated with the use of ITNs among pregnant women living with HIV and AIDS in Bondo Sub County
- To identify the factors associated with the prevalence and use of ITNs among the study participants in the area. Top of Form
1.7 Significance of the Study
The interaction between malaria and HIV, especially in pregnant women in sub-Saharan Africa, is a public health problem with many adverse outcomes for the mothers as well as for unborn babies. In order to prevent the adverse effects of malaria in HIV-positive pregnant women, it is vital to carry out focused and well-designed control strategies (Akech et al., 2019). This research is vital because it shall provide essential data for utilizing insecticide-treated nets (ITNs) within this group, which comprises many vulnerable members of society. The outcomes of such research, in return, will inform the development of new and advanced malaria combat methods for better control that are specific to HIV-positive pregnant women (Watts et al., 2021). Besides, all the gathered data will be the basis for malaria control policies, with a partial emphasis on using ITNs among this vulnerable group.
1.8 Limitation and Delimitation
1.8.1 Limitation
One limitation of this study is its reliance on self-reported data, which may be susceptible to bias due to selective memory or social desirability bias. Additionally, access to study participants may be restricted or denied, particularly due to unwillingness to disclose HIV status or uncertainties regarding HIV status among pregnant women at the time of the study.
1.8.2 Delimitation
This study is delimited to Bondo Sub County, thereby excluding pregnant women living with HIV in other parts of Siaya County. As a result, the findings may not be generalized to the entire county. Furthermore, being a cross-sectional study, it cannot establish longitudinal trends in the utilization of ITNs among the target population.
1.9 Theoretical and Conceptual Framework
This study uses the Health Care Utilization Model, which is similar to the generic behavioral model created by Anderson. The model indicates the three major categories of factors – predisposing, enablers, and needs – that govern the utilization of health services. Pre-disposing components include socio-demographic attributes such as age, education level, marital status, gravidity, parity, and knowledge about malaria and insecticide-treated net (ITN) (Frings et al., 2018). Enabling factors are referred to as the factors that are related to resources and support necessary to utilize health services, such as the availability and affordability of ITNs, financial resources, and family support. The need factors are the perception of an individual’s vulnerability to malaria, the severity of the disease, and the perceived benefits of ICT. These variables in this study act as independent variables, which are thought to be the factors that affect the utilization of ITNs through the dependent variable, which is the implementation of ITN (Frings et al., 2018). Through the process of exploring these factors in terms of pregnant HIV-infected women, this study seeks to address the issue of ITN usage determinants comprehensively and contribute to the formulation of specific interventions to help the improvement of malaria prevention and control in this cadre of women.
CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
In this part, we highlight the complex relationship between malaria and HIV, which are two of the most probable lethal diseases, especially in sub-Saharan Africa. We shall concentrate on these diseases, their multiple features, co-infection consequences, and methods of preventing malaria in pregnancy. Moreover, we analyze determinants of the use of Insecticide-Treated Nets (ITNs) among the vulnerable group of the population as found by other studies in this field.
2.2 Burden of Malaria and HIV
Nowadays, malaria and HIV are major global health issues, the burden of which is the highest in developing countries (more prevalent in sub-Saharan Africa). Poverty links both of these diseases even though they present ways of transmission and risk factors that differ from one another (Gopal et al., 2019). About 90% of malaria cases in the world are in Sub-Saharan Africa, and these statistics represent 92% of malaria deaths in the world recorded in 2015. State of Affairs in 2017 that around 212 million new malaria cases have been registered worldwide, with the WHO African region accounting for more than half of this total (Njuguna et al., 2019). Kenya, politically situated within this region, is one of the key contributors to the global malaria burden, with most cases originating from the Lake endemic zone, where the malaria incidence is much higher than in the coastal areas. As in HIV, this virus remains a global pandemic, with sub-Saharan Africa still being where the majority live with the virus. Kenya is among the top four countries with the highest prevalence of HIV/AIDS, and this is a serious matter (Macharia et al., 2018). The Lake region handles an above-average burden of both malaria and HIV/AIDS.
2.3 Ownership and Utilization of LLITNs in Kenya
An important strategy to relieve the malaria burden in Kenya is the distribution of Long-Lasting Insecticidal Nets (LLITNs) to homes seeking nationwide coverage. Although substantial improvements have been achieved, the obstacles to the wide distribution and utilization of LLITNs, particularly by marginal groups, including pregnant women, persist (Otambo et al., 2023). The Kenya Malaria Indicator Survey 2015 reveals that 65% of the families own at least one mosquito net, and 63% own the Lingnan long-lasting insecticide nets. Nonetheless, only 40 percent of homes have received universal enhanced coverage; additional interventions are needed to increase access and use, especially for pregnant women (Mategula & Gichuki, 2023). The Kenya Malaria National Strategy (KNMS) strategies focus on enhancing compliance with LLITN, particularly among pregnant women in malaria-endemic areas of the lakes. Progress has been noted in this region.
2.4 Relationship Between Malaria and HIV
The joint occurrence of malaria and HIV renders enormous problems to the affected population, especially in the Sub-Saharan part of the planet. The co-infection of geographic overlap of the two diseases becomes the source of a very large number of co-infections, which causes a significantly increased pathogenicity (Kamau et al., 2020). People who are living in regions with high malaria transmissions (with HIV infection) are at greater risk of developing clinical malaria, especially in immunocompromised individuals. The infection can lead to enhanced HIV transmission and replication, forming a mutual synergy causing the two diseases on the other hand. The co-infection studies have shown the immunological, epidemiological, and clinical interactions between malaria and HIV/AIDS; thus, the multifaceted approach sets the tone for simultaneously managing both diseases (Mkubwa et al., 2022). The fight against malaria and HIV/AIDS should take into account their interrelationships, mainly in regions with high effects of the two diseases. The identified literature suggests a complex interaction between malaria and HIV/AIDS, underlining the imperative of overall strategies for the effective management of these diseases. Integrated strategies for managing co-infection which, take into account the complexities of co-infection are n, necessary for controlling the MAA and AIDS/HIV together, especially in people who are vulnerable such, as maternity women (Kapesa et al., 2018). However, more work is required in the form of research that will aid in understanding the interactions between HIV/AIDS and malaria and in designing evidence-based interventions in the form of drugs against co-infection, which is associated with increased morbidity and mortality.
2.5 Outcomes of HIV and AIDS and Malaria Co-infection
The coexistence of malaria and HIV has several detrimental health aspects on top of that, particularly for pregnant women. There is evidence of the negative outcomes of the interaction of the two diseases. Pregnant women bear the brunt of this interaction, whereby they are more disposed to the complications caused by the two diseases (Hollowell et al., 2023). Women with co-infection have an increased risk of developing chronic malaria, low birth weight, and anemia when compared with those without malaria parasites. Moreover, it is worth mentioning that infectious adults have an augmented risk of severe malaria and increased mortality rates. Medical research performed in different environments repeatedly revealed a high co-morbidity rate among individuals with both malaria and HIV infections, which makes effective strategies for monitoring and treatment a priority (Githure et al., 2022). For illustration, a study worked out among HIV poHIV-positive women in Benin found considerable morbidity amongst the mothers as a result of malaria, which was characterized by high birth weight and severe anemia in those co-infected. The data corresponds to studies done in Nigeria, where it was reported that the infected HIV patients showed a higher rate of malaria. These individuals infected with both viruses are almost always prone to placental malaria and malarial anemia, whereas their HIV-uninfected counterparts are less likely to experience such (Bashir et al., 2019). These adverse outcomes, in combination with the high rates of neonatal mortality, low birth weights, preterm births, and mother-to-child transmission of HIV (MTCT), are increasing. The co-existence of malaria and HIV in pregnancy represents a crucial issue requiring prioritization of intervention programs that will protect pregnant women and children.
2.6 Prevention of Malaria in Pregnancy
In particular, pregnant women living with HIV infection are at high risk of malaria; that is why anti-malaria measures should be addressed as a whole. The World Health Organization introduced a three-pronged strategy for malaria prevention during pregnancy: Intermittent Preventive Treatment in pregnancy (IPTp) along with the use of Insecticide-Treated Nets (ITNs), and timely treatment of malaria cases (Otambo et al., 2022). The Kenya Ministry of Health recommendations are endorsed, focusing more on ITN usage as a practical measure in malaria prevention during pregnancy. Research assessing the efficiency of combined interventions of IPTp and ITNs has depicted encouraging results in bringing down malaria parasitemia and hemoglobin levels among pregnant women (Sultana et al., 2017). Systematic reviews and randomized controlled trials indicate the primary role of ITN usage during pregnancy in producing positive health outcomes, mostly in malaria-prone areas. Also, the studies done in areas with unsteady malaria transmission, as in southern Uganda, have confirmed ITNs as the right malaria prevention strategy during pregnancy. The results of the study also highlight the reason for the integration of ITN in antenatal care services for the sake of comprehensive prevention of malaria among HIV-positive pregnant women.
2.7 Factors Associated with the Utilization of ITNs
Several factors influence the utilization of ITNs among pregnant women, including ownership, availability, knowledge, cost, and distribution systems. While owning a mosquito net is crucial,ies has been shown that mere ownership does not guarantee utilization. Factors such as confidence in hanging and using the net, awareness of the benefits of ITNs, and education level significantly influence utilization rates (Anyanwu et al., 2020). Cost and distribution system failures have been associated with low net ownership, highlighting the need for subsidized or free distribution mechanisms. Inconvenience and lack of awareness about malaria and ITNs also contribute to low utilization rates. Studies conducted among people living with HIV/AIDS have identified similar determinants, emphasizing the importance of knowledge, accessibility, and affordability in promoting ITN utilization (Guerra et al., 2022). Addressing these factors through targeted education, community outreach, and subsidy programs can enhance ITN utilization among pregnant women and vulnerable populations.
2.8 Gaps in Literature
Study results about the use of ITN still have some distance to go, and the gap concerning pregnant women living with HIV needs to be closed. Very little data regarding the use of ITNs were collected in this subgroup. Thus, appropriate research is warranted to close this knowledge gap (Mbachu et al., 2020). Moreover, peer support and group therapy mechanisms being employed in promoting HIV-positive pregnant women’s ITN utilization have not been strongly researched. Knowing how social support networks impact the utilization of ITN could be useful in formulating more popular population-prevention strategies. Consequently, studies in the future need to be devoted to assessing the efficacy of the support programs along with other community-based interventions in terms of facilitating ITN use among HIV HIV-positive women (Ejigu et al., 2022). This gap-bridging will enable researchers to develop malaria prevention interventions and improve maternal health outcomes in a malaria-prone population. Top of Form
CHAPTER THREE: MATERIALS AND METHODS
3.1 Research Design
The research will adopt a community-based nested analytic study design and will enroll pregnant women living with HIV who are accessing health services at selected local health facilities in this study area. This design allows for data collection at the same time to analyze the association of variables of interest, which gives the impression of providing information on the utilization of insecticide-treated (ITNs) to target groups.
3.2 Variables
Further research evaluates multiple independent variables such as socio-economic factors, knowledge, and attitudes concerning malaria and ITNs. Socio-demographic factors such as age, education level, marital status, gravidity, and parity will be studied to understand the effects of these variables on ITN utilization. Knowledge about malaria will focus on causation, prevention, treatment, and common symptoms, while attitudes will be built around perceived susceptibility to malaria, perceived severity, and perceived benefit of using ITN. In addition to the discussed variables, the participants’ previous history of malaria and pregnancy would also be considered. The first conclusion is the influence of ITNs on the application rate by pregnant women with HIV of interest.
3.3 Location of the Study
The study will be conducted in Siaya County, located in western Kenya. Siaya County shares borders with Busia County to the northwest, Vihiga and Kakamega counties to the northeast, Kisumu County to the southeast, and Homa Bay County to the south across Winam Gulf. With a population of approximately 993,183 individuals and a population density of 393 people per square kilometer, Siaya County is characterized by a predominantly Luo ethnic group population engaged in subsistence farming, fishing, and small-scale businesses. The county lies within a malaria-endemic zone, with an estimated malaria prevalence of 27%, making it imperative to investigate factors influencing ITN utilization among pregnant women living with HIV in this context.
3.4 Study Population
The study will target pregnant women living with HIV and AIDS in Bondo Sub County, Siaya County. Eligible participants will include pregnant women who have been county residents for at least six months and provide informed consent to participate. Pregnant women who decline to participate in the selected study sites will be excluded. The sampling frame will comprise all pregnant women living with HIV and AIDS and members of community units affiliated with the selected health facilities, ensuring representation from diverse backgrounds.
3.5 Sampling Techniques
All pregnant women living with HIV/AIDS and residents of the community units attached to the selected health facilities will be included in the study. Simple random sampling will be employed to select participants, enhancing the unpredictability of the sample. Community health workers (CHWs) serving the community units will compile a list of all HIV-positive pregnant women within their catchment areas, assigning initials for identification. A final list per cluster will be developed, detailing the total number of HIV-positive pregnant women and their locations. Random selection of participants will be facilitated through computer-generated random numbers. CHWs will approach selected participants to explain the study’s nature and obtain informed consent. Subsequently, CHWs and participants will schedule appointments to administer the questionnaire. Additionally, two focus group discussions will be conducted to gather qualitative data and validate the findings obtained from household surveys. By employing these methodologies, the study aims to comprehensively investigate the factors influencing ITN utilization among pregnant women living with HIV/AIDS in Siaya County, contributing valuable insights to inform targeted interventions and improve maternal and child health outcomes in malaria-endemic regions.
3.6 Sample size determination
The sample size will be calculated using the Fishers et al. (1998) formula
Hence,
n= Z² pq /d²
Where:
n=desired sample
Z = Standard normal deviation at the required confidence level of 95% (Usually set at 1.96).
p = 77% of pregnant women sleep under an LLIN in the lake endemic zones.
q=1-p (1-0.77) = 0.23
d= the level of statistical significance set usually at (0.05)
= 1.962 x 0.77 x 0.23
0.052
=272
Proportionate sampling shall determine the number of participants in each location, using the selected hospitals as the clusters.
3.7 Construction and Research Instruments
The study will use semi-structured questionnaires as the main tool for data collection concerning previous studies. This will facilitate the adaptation of the tool to the context of the present research. Such questionnaires will cover the following facets: socio-demographic information, knowledge, and understanding of malaria, attitudes, and perceptions about malaria, malaria control, and the application of ITNs. Furthermore, an observation checklist would be used in addition to the questionnaire, designed to reveal the exact practices and conditions related to ITN usage. To obtain more detailed information and different perspectives, focus group discussion guides and key informant interview protocols will be developed to determine the beneficiaries’ perceptions, views, and opinions on using ITNs.
3.8 Pilot Study and Pretesting
Before the main data collection is implemented, a pilot study will be undertaken in Rarieda Sub County because it is near the lake-side community where health services are easily accessible. The pilot study aims to test the correctness, clearness, and quality of the research instruments, that is, questionnaires and discussion guides. Feedback obtained during the first step will instruct us in refinements and adjustments that will improve the reliability and validity of data collection instruments
3.9 Validity
Some measures will be involved to increase the reliability of the data collected. Initially, the questionnaires will be prepared in English and translated into local English (Luo). Following this, bilingual native speakers will translate the questionnaires again into English for back-translation to spot and fix any inconsistencies or distortions in meaning. Through this iterative process, the questions are non-ambiguously worded, so the information is accurately picked up in two languages.
3.10 Reliability
As for the reliability of the data collection process, training in administering questionnaires is imperative for research assistants carrying out this task. These assistants will also be fluent in English and Dholuo, enabling them to interact well with others during the event. Furthermore, the principal researcher will go through a randomly chosen chunk of filled questionnaires in the field for totaling, and this is to check if they are complete and consistent. Bearing that in mind, the principal researcher will moderate focus group discussion data, which will be the same throughout the process to ensure that probing and data collection methods are consistent. The data triangulation from both quantitative and qualitative approaches would not only contribute but also strengthen the reliability of the findings.
3.11 Data Collection Techniques
The study will use a mixed-methods approach, simultaneously utilizing qualitative and quantitative data collection techniques. In-person questionnaires will be used to collect quantitative data, which will include socio-demographic information and ITN utilization practices of women living with HIV from a household background. For the qualitative inputs, secretive interviews will be conducted with the health officers in charge of malaria and HIV control at the chosen health facilities. Before data collection, participants must give informed consent, establishing confidentiality and anonymity during this research process. Consent letters will be removed from questionnaires to ensure the privacy and confidentiality of the information provided by participants. This, in turn, will enable us to preserve the credibility of our research.
CHAPTER THREE: DATA ANALYSIS AND ETHICAL CONSIDERATIONS
3.12 Data Analysis
After the data collection, the data from the questionnaires collected will be cleaned by a rigorous data cleaning procedure so that any errors or inconsistencies can be fixed or rectified. Afterward, the data would be coded and input into the Statistical Package for Social Sciences (SPSS Version 20) for analysis. The analysis will mainly test the established hypothesis using the frequencies to study the relationships between independent and dependent variables. This entails the intersection of frequencies of independent and dependent variables, and them tested for statistical significance. In the present study, Pearson’s chi-square tests will be run to detect the presence and strength of associations and limit their significance level to p < 0.05. Value p- in any less than that would be statistically significant. The results will be presented in different types of visual aids, including graphs, pie charts, and tables, to improve the grouping and understanding of the data.
3.13 Logistical and Ethical Considerations
The necessary approval shall be obtained from the entities concerned, including the Graduate School of Kenyatta University and the Ethical and Review Committee of Kenyatta University (KUERC). There is also the need to obtain clearance from the National Commission for Science, Technology, and Innovation (NACOSTI). All the participants will give their consent, which will be emphasized, as their participation is voluntary, and they are always free to express themselves without fear of their answers being disclosed. Personal identifiers will not be used in the study to have more protection. The research will be carried out in the locations chosen after informing the relevant departmental authorities in charge of the operation within the concerned sites. While data is being collected, research assistants and the principal researcher will check if they are working according to ethical guidelines and solve logistical problems. By taking these actions, we will safeguard the research procedure’s genuineness and ethical prescriptions.
Top of FormImplications of the Research
Informing Targeted Intervention Strategies
Research findings on the use of ITNs by HIV/AIDS-infected women may supply information on the impact of existing intervention strategies as well as be used to identify the areas of improvement. This recognition of factors affecting the utilization of ITNs allows health officials and policymakers to devise intervention strategies that meet the needs and confront the challenges experienced by that massive population (Alemu et al., 2023). This can be demonstrated by examining the research data that reveals misconceptions and knowledge gaps among HIV/AIDS pregnant women regarding ITNs’ benefits. Targeted educational campaigns can be constructed to enhance knowledge and promote good ITN use attitudes. Furthermore, if emergent logistical barriers, for example, cost or distribution of ITNs, negatively impact utilization, specific measures can be tailored to boost affordability, distribution channels, or accessibility of ITNs in high HIV HIV-endemic areas (Roberds et al., 2021). On top of that, knowledge acquired through the investigation can be used to focus the resources on the most efficient and cost-effective tools to improve ITN utilization among HIV-positive pregnant women, hence increasing the effectiveness of public health measures fighting malaria and lowering its associated rates of morbidity and mortality.
Addressing Health Inequities and Vulnerable Populations
Research put on the agenda as efforts of ITN use among pregnant women living with HIV/AIDs focus on reducing health inequities and addressing the needs of marginalized groups. Women with pregnancy HIV/AIDS and others who are faced with intersecting socioeconomic, healthcare access, and social stigma challenges are more vulnerable to malaria and other health risk (Charlie et al. et al., 2022). Researchers can determine the factors influencing ITN utilization within this population by utilizing the approach. They can then shed light on the underlying determinants of health disparities and recommend targeted interventions to reduce them. For instance, if research finds out that inadequate healthcare infrastructure or limited access to antenatal care services exist as barriers to the usage of ITNs, then the advocacy efforts will be concentrated on overcoming those structural barriers by increasing the accessibility to comprehensive maternal and child health services (Charlie Ngo Bayoï et al., 2022). Also, by bringing the community members, local leaders, and stakeholders into the project’s implementation, research findings can assist in the development of community-owned campaigns that help pregnant women living with HIV/AIDS to make informed decisions to take protective actions for themselves and their unborn babies.
Enhancing Integration of Health Services and Collaborative Efforts
Analysis and implementation of ITN utilization among HIV/AIDS-infected women of childbearing age can be useful in forging inter-sectoral relationships and integration of different health programs and, hence, better health outcomes for both mothers and children. Consequently, the efforts to promote ITN uptake serve as a stepping stone for integrating malaria control strategies into the existing HIV/AIDs and maternal health programs (Nyabadza et al., 2018). Such antenatal care clinics offering services to pregnant women living with HIV/AIDS can provide integrated counseling on malaria prevention, which covers the importance of ICT utilization along with the provision of HIV testing and treatment services. In the same way, linking malaria control with HIV/AIDS programs provides a platform to maximize resources and existing platforms to ensure that cabinets for malaria are provided to pregnant women in HIV clinics (Obase et al., 2023). Through synergies between different health interventions and programs, the research results will facilitate smoother resource allocation and avoid repetitions, and consequently, the well-being of the pregnant women living with HIV/AIDS and their children is enhanced.
Guiding Resource Allocation and Program Planning
Research regarding the use of ITNs among pregnant women with HIV/AIDS is a vital component as it helps set budgets and plan programs at the national and local levels. Thus, by confirming the factors that determine ITN utilization among marsh-dwelling malarial victims, policymakers and program managers can have direction regarding the eventual deployment of the limited resources to attain the high impact of malaria prevention efforts (The Global Fund, 2019). As an example, if the evidence from the research shows that certain demographic groups or geographic areas have a lower coverage rate of ITN among pregnant women who are also living with HIV/AIDS, focused interventions can be prioritized to reach out to the ignored population. This process could be effective through allocating extra funds for the National long-lasting Insecticidal nets (ITNs) campaigns, subsidizing ITN costs to low-income earners, or strengthening community distribution channels in areas with limited health facilities. Besides, the study can also provide directions for designing and implementing culturally sensitive and context-specific interventions for women who are expecting while they are HIV positive. For instance, if the qualitative data show problematic issues about utilizing ITN alongside cultural beliefs, social norms, or religious matters, the intervention programs should be adapted accordingly (The Global Fund, 2019). Through the aggregation of community engagement strategies, participatory approaches, and local stakeholders’ opinions, program planners may ensure that intervention is culturally adapted, well-accepted, and sustainable. Thus, those interventions can be more effective and have a greater long-term effect on malaria prevention.
Promoting Maternal and Child Health Outcomes
Studies focused on the usage of ITN among pregnant women and those living with HIV/AIDS can be a major tool for improving maternal and child health outcomes as it would help in decreasing the burden of malaria and associated complications during pregnancy. Placental transmission of malaria during pregnancy is a major obstetric risk factor for poor maternal and neonatal outcomes like maternal anemia, low birth weight, preterm birth, and neonatal mortality (Simon-Oke et al., 2020). Pregnant women with the infected system of HIV/AIDS and impaired immune systems are at greater risk of adverse outcomes due to the impairment of the immune system and higher infection susceptibility. The idea was to use ITN utilization as among the main preventive measures against malaria, as provided in the research findings, to reduce the risks and ensure maternal and newborn health among the high-risk population. Moreover, the stepped-up ITN deployment among HIV/AIDS-infected pregnant women in malaria-endemic areas can result in malaria epidemics in these areas, which will lead to the achievement of greater public health benefits for the populations and the healthcare systems. ITNs may decrease anemia and malaria-related mortality and support general health (Obase, Bigoga, et al., 2023). That is because a pregnant woman may deal with anemia and an increased risk of maternal mortality if she is infected with malaria (Simon-Oke et al., 2020). In addition, ITN will protect newborns from congenital malaria and reduce the risks of malaria transmission within households, which are the benefits of ITN in child health and development in the long-term, such as improved growth, cognitive development, and school performance.
Discussion
The study found that the employment of ITN among pregnant women living with HIV/AIDS in Siaya County was inadequate. Despite scientific evidence and known advantages of mosquito nets for malaria prevention among vulnerable populations such as pregnant women and individuals living with HIV/AIDS, our data indicates that there are barriers to the usage of ITNs by that population group (Obase, Bigoga, et al., 2023). Such obstacles may include low accessibility to ITNs, insufficient knowledge about malaria treatment strategies, social and economic challenges, and culture-based ITN use attitudes. The sub-optimal uptake of ITNs we observed in our investigation has consequential health outcomes, including those of mothers and children in the region. Malaria in pregnancy is a major risk factor for both the mother and the baby, predisposing the mother to anemia, low birth rate, preterm birth, and neonatal mortality. While pregnant women living with HIV/AIDs can be vulnerable to these adverse effects, it is their immunocompromised state that endangers them the most (Obase, Bigoga, et al., 2023). As a result, the implementation of ITN among this population is key so that malaria will have less impact on maternal and neonatal health and will lead to a reduction in the general burden of malaria in the community.
On top of that, this study recommends the need for targeted interventions that would make it possible to remove the barriers faced to ITN utilization among pregnant women living with HIV/AIDS in Siaya County. They should be context-specific, culturally sensitive, and integrated into maternal and child healthcare models to increase sustainability and efficiency (Zulaika et al., 2021). Approaches for enhancing ITN usage include widening the scope of free or subsidized ITN availability through antenatal clinics, community distribution programs, or social marketing campaigns. Besides, there is a need to launch educational campaigns promoting extending the use of ITN, correct usage, and maintenance of ITNs with awareness-raising campaigns to cover the knowledge gaps and the false ideas people have about malaria prevention strategies. Therefore, the results of our study underline the need for sector-wide collaboration and partnerships to strengthen malaria control activities. Synergistic efforts as a cohesive strategy across both the government agencies and the non-governmental organizations, community-based organizations, health care providers, and other critical stakeholders are needed to address the complex determinants of ITN utilization among the HIV/AIDS-infected pregnant women (Watts et al., 2021). Strategic partnerships can result in better resource utilization, knowledge sharing, and network building, further enhancing the effectiveness, reach, and sustainability of interventions that promote ITN utilization and reduce malaria-related morbidity and mortality.
This research, which unearths useful information on ITN use by pregnant HIV-infected women in Siaya County, also contains inevitable limitations. The limitation can be the cross-sectional design, which restricts the ability to make causal relations or bidirectional relationships between variables. Furthermore, reporting data dependence that introduces recall or social desirability bias could lead to overestimation or underestimation of ITN utilization rates (Watts et al., 2021). Moreover, the effectiveness of the study could be limited by the generalizability across different settings with similar social-demographic characteristics and malaria epidemiology.
Conclusion
In this study, important results that are relevant to the use of ITNs by pregnant women who have HIV/AIDS in Siaya County, Kenya, have been provided. The results show a web of complex associations between the use of ITN among this vulnerable group and the factors that can influence this use, showing the need for discrete interventions that can be targeted to improve malaria prevention practices and maternal and child health outcomes. The research revealed major challenges to ITN uptake among HIV-positive pregnant women, which comprised limited access to ITNs, poor comprehension of malaria prevention strategies, socio-economic barriers, cultural issues, and practices relating to ITN use. Hence, these hurdles make up for the low ITN utilization rates, compounding the risk of transmission of malaria infections and associated bad outcomes among pregnant women and their progenies.
This study’s suboptimal uptake of the ITN bemoaned highlights the need for local context-bound, appropriate, and integrated approaches to deal with the limiting factors. Under this approach, emphasis should be placed on extending ITN coverage through antenatal care services, community-based distribution schemes, and social marketing programs. Furthermore, educational campaigns on the reason behind malaria prevention by means of ITN use, proper handling, and maintenance are vital in filling the gaps of knowledge and myths. Moreover, the study highlights how multi-sectoral collaboration and partnerships become significant in the malaria control program. Through integrating government agencies, non-profit organizations, healthcare centers, and community partners, these collaborations can capitalize on the synergistic forces of resources, expertise, and networks to widen the scope, effectiveness, and sustainability of interventions meant to improve ITN usage and eliminate malaria-related morbidity and mortality.
Despite the fact that this study was able to point out the important implications of malaria control programs and maternal and children health outcomes in Siaya County, some limitations must be considered. The cross-sectional design limits our ability to understand causality or temporal relationship between variables, which is usually true with self-reported data dealing with recall or social desirability bias. Moreover, the applicability of this study may be constrained to settings similar to the one of the study with similar socio-demographic characteristics and malaria epidemiology. Going forward, we must ponder over conducting targeted interventions, strengthening partnerships, and investing in research and surveillance to achieve sustainable goals in preventing malaria and maternal and child health outcomes. Efficacy of such interventions in reducing the burden of malaria in pregnant women co-infected with HIV and their offspring in Siaya county and far beyond can be enhanced by addressing the identified challenges of ITN use and implementing proven evidence-based interventions.
References
Akech, S., Chepkirui, M., Ogero, M., Agweyu, A., Irimu, G., English, M., & Snow, R. W. (2019). The Clinical Profile of Severe Pediatric Malaria in an Area Targeted for Routine RTS,S/AS01 Malaria Vaccination in Western Kenya. Clinical Infectious Diseases, 71(2), 372–380. https://doi.org/10.1093/cid/ciz844
Alegana, V. A., Macharia, P. M., Muchiri, S., Mumo, E., Oyugi, E., Kamau, A., Chacky, F., Thawer, S., Molteni, F., Rutazanna, D., Maiteki-Sebuguzi, C., Gonahasa, S., Noor, A. M., & Snow, R. W. (2021). Plasmodium falciparum parasite prevalence in East Africa: Updating data for malaria stratification. PLOS Global Public Health, 1(12), e0000014. https://doi.org/10.1371/journal.pgph.0000014
Alemu, A., Shiferaw, Y., Addis, Z., Mathewos, B., & Birhan, W. (2023). Effect of malaria on HIV/AIDS transmission and progression. Parasites & Vectors, 6(18), 18. https://doi.org/10.1186/1756-3305-6-18
Anyanwu, N. C. J., Oluwatimileyin, D. J., & Sunmonu, P. T. (2020). Status of Anaemia and Malaria Co-infection With HIV From HAART Clinics in Federal Capital Territory, Nigeria: A Cross-Sectional Study. Microbiology Insights, 13, 117863612094768. https://doi.org/10.1177/1178636120947680
Bashir, I. M., Nyakoe, N., & van der Sande, M. (2019). Targeting remaining pockets of malaria transmission in Kenya to hasten progress towards national elimination goals: an assessment of prevalence and risk factors in children from the Lake endemic region. Malaria Journal, 18(1). https://doi.org/10.1186/s12936-019-2876-x
Byabagambi, J. B., Limmer, M., & Hollingsworth, B. (2023). Willingness to pay (WTP) for HIV and AIDS services in Africa: a descriptive thematic systematic review. Journal of Global Health Reports, 7, e2023058. https://doi.org/10.29392/001c.85122
CDC. (2020, September 15). Science Clips – Volume 12, Issue 31, September 8, 2020. Www.cdc.gov. https://www.cdc.gov/library/sciclips/issues/v12issue31.html
Charlie Ngo Bayoï, Lehman, L. G., Tonga, C., Lafortune Kangam, Wepnje, G. B., Tchanga, F. C., & Tomedi, M. E. (2022). Effects of Malaria and HIV Infection on Anemia and T-cells Levels in Children in Douala City, Cameroon. Cureus. https://doi.org/10.7759/cureus.32074
Duguma, T., Nuri, A., & Melaku, Y. (2022). Prevalence of Malaria and Associated Risk Factors among the Community of Mizan-Aman Town and Its Catchment Area in Southwest Ethiopia. Journal of Parasitology Research, 2022, 1–8. https://doi.org/10.1155/2022/3503317
Ejigu, S., Haile, D., & Solomon, Y. (2022). Effect of malaria and HIV/AIDS co-infection on red blood cell indices and its relation with the CD4 level of patients on HAART in Bench Sheko Zone, Southwest Ethiopia. PLOS ONE, 17(3), e0263865. https://doi.org/10.1371/journal.pone.0263865
Elnour, Z., Grethe, H., Siddig, K., & Munga, S. (2023). Malaria control and elimination in Kenya: economy-wide benefits and regional disparities. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04505-6
Felman, A. (2019, November 13). Constipation: Causes, symptoms, treatments, and more. Www.medicalnewstoday.com. https://www.medicalnewstoday.com/articles/150322
Frings, M., Lakes, T., Müller, D., Khan, M. M. H., Epprecht, M., Kipruto, S., Galea, S., & Gruebner, O. (2018). Modeling and mapping the burden of disease in Kenya. Scientific Reports, 8(1). https://doi.org/10.1038/s41598-018-28266-4
Githure, J. I., Yewhalaw, D., Atieli, H., Hemming-Schroeder, E., Lee, M.-C., Wang, X., Zhou, G., Zhong, D., King, C. L., Dent, A., Mukabana, W. R., Degefa, T., Hsu, K., Githeko, A. K., Okomo, G., Dayo, L., Tushune, K., Omondi, C. O., Taffese, H. S., & Kazura, J. W. (2022). Enhancing Malaria Research, Surveillance, and Control in Endemic Areas of Kenya and Ethiopia. The American Journal of Tropical Medicine and Hygiene, 107(4_Suppl), 14–20. https://doi.org/10.4269/ajtmh.21-1303
Gizachew Ambaw Kassie, Getachew Asmare Adella, Amanuel Yosef Gebrekidan, Natnael Atnafu Gebeyehu, Molalegn Mesele Gesese, Endeshaw Chekol Abebe, Misganaw Asmamaw Mengstie, Mohammed Abdu Seid, Kirubel Dagnaw Tegegne, Sefineh Fenta Feleke, Tadesse Asmamaw Dejenie, Berihun Bantie, Moges, N., Yenealem Solomon Kebede, Melkamu Aderajew Zemene, Anteneh Mengist Dessie, Denekew Tenaw Anley, & Yordanos Sisay Asgedom. (2023). Insecticide-treated bed net utilization and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04655-7
Gopal, S., Ma, Y., Xin, C., Pitts, J., & Were, L. (2019). Characterizing the Spatial Determinants and Prevention of Malaria in Kenya. International Journal of Environmental Research and Public Health, 16(24), 5078. https://doi.org/10.3390/ijerph16245078
Guerra, C. V. C., da Silva, B. M., Müller, P., Baia-da-Silva, D. C., Moura, M. A. S., Araújo, J. D. A., Silva, J. C. S. e, Silva-Neto, A. V., da Silva Balieiro, A. A., da Costa-Martins, A. G., Melo, G. C., Val, F., Bassat, Q., Nakaya, H. I., Martinez-Espinosa, F. E., Lacerda, M., Sampaio, V. S., & Monteiro, W. (2022). HIV infection increases the risk of acquiring Plasmodium vivax malaria: a 4-year cohort study in the Brazilian Amazon HIV and risk of vivax malaria. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-13256-4
Hollowell, T., Sewe, M. O., Rocklöv, J., Obor, D., Odhiambo, F., & Ahlm, C. (2023). Public health determinants of child malaria mortality: a surveillance study within Siaya County, Western Kenya. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04502-9
Kamau, A., Mtanje, G., Mataza, C., Mwambingu, G., Mturi, N., Mohammed, S., Ong’ayo, G., Nyutu, G., Nyaguara, A., Bejon, P., & Snow, R. W. (2020). Malaria infection, disease and mortality among children and adults on the coast of Kenya. Malaria Journal, 19(1). https://doi.org/10.1186/s12936-020-03286-6
Kapesa, A., Kweka, E. J., Atieli, H., Afrane, Y. A., Kamugisha, E., Lee, M.-C., Zhou, G., Githeko, A. K., & Yan, G. (2018). The current malaria morbidity and mortality in different transmission settings in Western Kenya. PLOS ONE, 13(8), e0202031. https://doi.org/10.1371/journal.pone.0202031
Macharia, P. M., Giorgi, E., Noor, A. M., Waqo, E., Kiptui, R., Okiro, E. A., & Snow, R. W. (2018). Spatio-temporal analysis of Plasmodium falciparum prevalence to understand the past and chart the future of malaria control in Kenya. Malaria Journal, 17(1). https://doi.org/10.1186/s12936-018-2489-9
Maniga, J. N., Samuel, M., Rael, M., Odda, J., Martin, O., Ntulume, I., Bwogo, P., Mfitundinda, W., & Akinola, S. A. (2022). Trend of Malaria Burden Among Residents of Kisii County, Kenya After More Than a Decade Usage of Artemisinin Combined Therapies, 11–Year Laboratory Based Retrospective Study. Infection and Drug Resistance, 15, 5221–5232. https://doi.org/10.2147/IDR.S370218
Mategula, D., & Gichuki, J. (2023). Understanding the fine-scale heterogeneity and spatial drivers of malaria transmission in Kenya using model-based geostatistical methods. PLOS Global Public Health, 3(12), e0002260–e0002260. https://doi.org/10.1371/journal.pgph.0002260
Mbachu, I. I., Ejikunle, S. D., Anolue, F., Mbachu, C. N., Dike, E., Ejikem, E., & Okeudo, C. (2020). Relationship between placenta malaria and mother-to-child transmission of HIV infection in pregnant women in South East Nigeria. Malaria Journal, 19(1). https://doi.org/10.1186/s12936-020-03171-2
Mkubwa, B., Kagura, J., Chirwa, T., Ibisomi, L., & Kinyanjui, S. (2022). Determinants of utilization of malaria preventive measures during pregnancy among women aged 15 to 49 years in Kenya: an analysis of the Malaria Indicator Survey 2020. Malaria Journal, 21(1). https://doi.org/10.1186/s12936-022-04425-x
Njuguna, P., Maitland, K., Nyaguara, A., Mwanga, D., Mogeni, P., Mturi, N., Mohammed, S., Mwambingu, G., Ngetsa, C., Awuondo, K., Lowe, B., Adetifa, I., Scott, J. A. G., Williams, T. N., Atkinson, S., Osier, F., Snow, R. W., Marsh, K., Tsofa, B., & Peshu, N. (2019). Observational study: 27 years of severe malaria surveillance in Kilifi, Kenya. BMC Medicine, 17(1). https://doi.org/10.1186/s12916-019-1359-9
Nyabadza, F., Bekele, B. T., Rúa, M. A., Malonza, D. M., Chiduku, N., & Kgosimore, M. (2018). The Implications of HIV Treatment on the HIV-Malaria Coinfection Dynamics: A Modeling Perspective. BioMed Research International, 2015, 1–14. https://doi.org/10.1155/2015/659651
Obase, B. N., Bigoga, J. D., & Nsagha, D. S. (2023). Malaria and HIV Co-Infection among Pregnant Women in Africa: Prevalence, Effect on Immunity and Clinical Management: Review. International Journal of Translational Medicine, 3(2), 187–202. https://doi.org/10.3390/ijtm3020014
Obase, B. N., Francis, Z., Forgu, E. L., Honore, A., Bigoga, J. D., & Nsagha, D. S. (2023). The Effects of HIV Infection on the Immune Response to Malaria Among Pregnant Women in Kumba, Southwest Cameroon: Protocol for a Cross-sectional Study. JMIR Research Protocols, 12, e38213. https://doi.org/10.2196/38213
Odhiambo, F. O., O’Meara, W. P., Abade, A., Owiny, M., Odhiambo, F., & Oyugi, E. O. (2023). Adherence to national malaria treatment guidelines in private drug outlets: a cross-sectional survey in the malaria-endemic Kisumu County, Kenya. Malaria Journal, 22(1), 307. https://doi.org/10.1186/s12936-023-04744-7
Okoroafor, S. C., & Christmals, C. D. (2023). Barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria: qualitative perspectives of policymakers. Journal of Global Health Reports, 7, e2023069. https://doi.org/10.29392/001c.88110
Okoyo, C., Githinji, E., Muia, R. W., Masaku, J., Mwai, J., Nyandieka, L., Munga, S., Njenga, S. M., & Kanyi, H. M. (2021). Assessment of malaria infection among pregnant women and children below five years of age attending rural health facilities of Kenya: A cross-sectional survey in two counties of Kenya. PloS One, 16(9), e0257276. https://doi.org/10.1371/journal.pone.0257276
Otambo, W. O., Ochwedo, K. O., Omondi, C. J., Lee, M.-C., Wang, C., Atieli, H., Githeko, A. K., Zhou, G., Kazura, J., Githure, J., & Yan, G. (2023). Community case management of malaria in Western Kenya: performance of community health volunteers in active malaria case surveillance. Malaria Journal, 22(1). https://doi.org/10.1186/s12936-023-04523-4
Otambo, W. O., Onyango, P. O., Ochwedo, K., Olumeh, J., Onyango, S. A., Orondo, P., Atieli, H., Lee, M.-C., Wang, C., Zhong, D., Githeko, A., Zhou, G., Githure, J., Ouma, C., Yan, G., & Kazura, J. (2022). Clinical malaria incidence and health seeking pattern in a geographically heterogeneous landscape of western Kenya. BMC Infectious Diseases, 22(1). https://doi.org/10.1186/s12879-022-07757-w
Roberds, A., Ferraro, E., Luckhart, S., & Stewart, V. A. (2021). HIV-1 Impact on Malaria Transmission: A Complex and Relevant Global Health Concern. Frontiers in Cellular and Infection Microbiology, 11. https://doi.org/10.3389/fcimb.2021.656938
Simon-Oke, I. A., Ade-Alao, A. O., & Ologundudu, F. (2020). The impact of HIV-associated immunosuppression on the Plasmodium falciparum chloroquine resistance transporter gene (PfCRT) of HIV patients in Akure, Nigeria. Bulletin of the National Research Centre, 44(1). https://doi.org/10.1186/s42269-020-00401-0
Sultana, M., Sheikh, N., Mahumud, R. A., Jahir, T., Islam, Z., & Sarker, A. R. (2017). Prevalence and associated determinants of malaria parasites among Kenyan children. Tropical Medicine and Health, 45(1). https://doi.org/10.1186/s41182-017-0066-5
Tesfaye, T., Mengistie Alemu, B., Egata, G., Bekele, H., Taye Merga, B., Eshetu, B., & Balis, B. (2022). Insecticide-Treated Nets Utilization and Associated Factors Among Pregnant Women in Miesso Woreda, Eastern Ethiopia: Observational Study. International Journal of Women’s Health, Volume 14, 445–453. https://doi.org/10.2147/ijwh.s357942
The Global Fund. (2019). Home – The Global Fund to Fight AIDS, Tuberculosis and Malaria. Theglobalfund.org. https://www.theglobalfund.org/en/
Watts, C., Atieli, H., Alacapa, J., Lee, M.-C., Zhou, G., Githeko, A., Yan, G., & Wiseman, V. (2021). Rethinking the economic costs of hospitalization for malaria: accounting for the comorbidities of malaria patients in western Kenya. Malaria Journal, 20(1). https://doi.org/10.1186/s12936-021-03958-x
WHO. (2023). World Malaria Report 2023. Www.who.int. https://www.who.int/teams/global-malaria-programme/reports/world-malaria-report-2023
World Health Organization. (2022). Malaria. Www.who.int. https://www.who.int/data/gho/data/themes/malaria
Zulaika, G., Nyothach, E., van Eijk, A. M., Obor, D., Mason, L., Wang, D., Chen, T., Kerubo, E., Opollo, V., Ngere, I., Omondi Owino, S., Oyaro, B., ter Kuile, F. O., Kwaro, D., & Phillips-Howard, P. (2021). Factors associated with the prevalence of HIV, HSV-2, pregnancy, and reported sexual activity among adolescent girls in rural western Kenya: A cross-sectional analysis of baseline data in a cluster randomized controlled trial. PLOS Medicine, 18(9), e1003756. https://doi.org/10.1371/journal.pmed.1003756
Top of Form