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Trends in and Factors Associated with Malaria Prevention in Mali [FA132] Trends in and Factors Associated with Malaria Prevention in Mali Further Analysis of the Mali Demographic and Health Surveys and Malaria Indicator Surveys 2006-2018 DHS Further Analysis Reports No. 132 April 2020 This publication was produced for review by the United States Agency for International Development. It was prepared by Hannah Koenker, Madina Konate Coulibaly, and Issa Bouare. DHS Further Analysis Report No. 132 Trends in and Factors Associated with Malaria Prevention in Mali: Further Analysis of the Mali Demographic and Health Surveys and Malaria Indicator Surveys 2006-2018 Hannah Koenker1 Madina Konate Coulibaly2 Issa Bouare3 ICF Rockville, Maryland, USA April 2020 1 Hannah Koenker, Elliris Global Health, USA 2 National Malaria Control Program (Programme National de Lutte contre le Paludisme – PNLP), Mali 3 National Institute of Statistics (Institut National de la Statistique – INSTAT) Corresponding author: Hannah Koenker, International Health and Development, ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: 301-407-6500; fax: 301-407-6501; email: [email protected] Acknowledgments: This study was supported by the USAID/Mali. The USAID Mission in Mali provided support and funding under the DHS-8 contract. Gratitude is extended to Jules Mihigo and Celia Jane for their thoughtful contributions in generating the concept for the analysis and in reviewing the results. Editor: Diane Stoy Document Production: Chris Gramer This report presents findings from a further analysis of the 2018 Mali Demographic and Health Survey (MDHS). This report is a publication of The DHS Program, which collects, analyzes, and disseminates data on fertility, family planning, maternal and child health, nutrition, and HIV/AIDS. Funding was provided by the U.S. Agency for International Development (USAID) through the DHS Program (#720-0AA-18C- 00083). The opinions expressed here are those of the authors and do not necessarily reflect the views of USAID and other cooperating agencies. Recommended citation: Koenker, Hannah, Madina Konate Coulibaly, and Issa Bouare. 2020. Trends in and Factors Associated with Malaria Prevention in Mali: Further Analysis of the Mali Demographic and Health Surveys and Malaria Indicator Surveys 2006-2018. DHS Further Analysis Reports No. 132. Rockville, Maryland, USA: ICF. CONTENTS TABLES ........................................................................................................................................................ v FIGURES ...................................................................................................................................................... v ABSTRACT ................................................................................................................................................ vii ABBREVIATIONS ....................................................................................................................................... ix 1 INTRODUCTION .............................................................................................................................. 1 1.1 Background ......................................................................................................................... 1 1.2 Context of National Malaria Control .................................................................................... 1 1.2.1 ITNs ........................................................................................................................ 1 1.2.2 IPTp ........................................................................................................................ 2 1.3 Objective of the Report ....................................................................................................... 2 2 DATA AND METHODS ................................................................................................................... 3 2.1 Data ..................................................................................................................................... 3 2.2 Methods .............................................................................................................................. 5 2.2.1 Indicators ................................................................................................................ 5 2.2.2 Analysis .................................................................................................................. 6 3 RESULTS ........................................................................................................................................ 7 3.1 Parasitemia and Anemia ..................................................................................................... 7 3.1.1 Regional trends in parasitemia and anemia .......................................................... 8 3.2 Insecticide-Treated Nets ..................................................................................................... 8 3.2.1 Regional trends in ITN ownership and access ...................................................... 9 3.2.2 Regional trends in ITN use .................................................................................. 13 3.2.3 Regional trends in children’s ITN use .................................................................. 15 3.2.4 Regional trends in pregnant women’s ITN use .................................................... 16 3.2.5 Age and gender trends in ITN use ....................................................................... 17 3.2.6 Seasonal trends in ITN use .................................................................................. 18 3.3 Intermittent Preventive Treatment of Malaria in Pregnancy ............................................. 19 3.3.1 National trends in IPTp ........................................................................................ 21 3.3.2 Regional trends in IPTp ....................................................................................... 22 3.3.3 Regional trends in IPTp among women who attend ANC ................................... 25 3.3.4 Reasons for not taking SP during pregnancy ...................................................... 26 4 CONCLUSIONS AND RECOMMENDATIONS ............................................................................. 28 REFERENCES ............................................................................................................................................ 31 APPENDICES ............................................................................................................................................. 33 iii TABLES Table 1 Sample sizes and notes for 2006-2018 Demographic and Health Surveys and Malaria Indicator Surveys .......................................................................................... 3 Table 2 Malaria prevention indicators included in the study ................................................... 5 FIGURES Figure 1 Timing of survey fieldwork and regional mass ITN campaigns ................................. 2 Figure 2 Map of Mali ................................................................................................................ 4 Figure 3 Parasitemia and anemia in children age 6-59 months .............................................. 7 Figure 4 Parasitemia (via RDT) in children age 6-59 months by region .................................. 8 Figure 5 Anemia in children age 6-59 months by region ......................................................... 8 Figure 6 National ITN indicators ............................................................................................... 9 Figure 7 Household ownership of any ITN by region ............................................................. 11 Figure 8 Household ownership of at least 1 ITN per 2 people by region ............................... 11 Figure 9 Population access to ITN by region ......................................................................... 12 Figure 10 Population access to ITN as a function of time since the most recent distribution. Data points include one or more regions based on date of the survey fieldwork and distribution dates of the most recent campaign. .................... 12 Figure 11 Source of ITNs by region ......................................................................................... 13 Figure 12 Population use of an ITN the previous night by region ............................................ 14 Figure 13 ITN use: access ratio by region ............................................................................... 14 Figure 14 Percent of nets used the previous night by region .................................................. 15 Figure 15 Use of ITN by children under age 5 by region ......................................................... 16 Figure 16 Use of ITN the previous night by children under age 5, in households with at least 1 ITN ................................................................................................................ 16 Figure 17 Use of ITN the previous night by pregnant women ................................................. 17 Figure 18 Use of ITN the previous night by pregnant women, in households with at least 1 ITN ........................................................................................................................ 17 Figure 19 Age and gender trends in ITN use, stratified by household net supply ................... 18 Figure 20 Seasonal trends in ITN use given access, national ................................................
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