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JOURNAL CLUB…

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Wednesday 3 May 2023 JOURNAL CLUB 2

Presenter : Dr. Surendran Venkataraman

Type of Session : Journal article discussion

Title : The use of mosquito repellents at three sites in India with declining malaria transmission: surveys in the community and clinic

Date : 20/12/2016

Time : 2-4PM

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• Title : The use of mosquito repellents at three sites in India with declining malaria transmission: surveys in the community and clinic.

• Volume/Issue/Page number :9/1/418

• Date Published :27 July 2016

• DOI :10.1186/s13071-016-1709-9

•Authors list :Anna Maria van Eijk , Lalitha Ramanathapuram, Patrick L. Sutton, Jane M. Carlton ,Steven A. Sullivan, Nandini Peddy, Sandhya Choubey, Stuti Mohanty, K Pradhan, Aswin Asokan, Sangamithra Ravishankaran, G Sri Lakshmi Priya, Justin Amala Johnson, Sangeetha Velayutham, Deena Kanagaraj, Alex Eapen ,Ankita Patel, Nisha Desai, Nikunj Tandel, H. C. Srivasatava, Ranveer Singh, Samuel C. Wassmer, and S. K. Sharma.

Reasons for choosing: Indexed, International journal with impact factor, Recently published, Peer reviewed, Field of community Medicine, field based survey set in India.

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BACKGROUND:

1. Vector-borne diseases are a considerable burden in India

commonest being Malaria

2. Use of protection against mosquito bites may result in prevention

of these diseases in addition to reducing mosquito annoyance and

itching.

3. For malaria control , insecticide-treated nets (ITNs) and indoor

residual spraying are methods with proven efficacy.

4. Repellent use is widespread in India, regularly surpassing net use.

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BACKGROUND:

5. The efficacy of these personal protection methods has not been

widely evaluated.

6. The evaluation the epidemiology of malaria at three sites in India

(Chennai, Nadiad and Raurkela), provided an opportunity to assess

1. which personal protection methods were used,

2. who was using them and

3. if there was an association between their use and malaria

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STROBE check list

Item Comments

Title and abstract

1.(a) Indicate the study’s design with a commonly used term in the title or the abstract

The title does not convey the study design clearly

1.(b) Provide in the abstract an informative and balanced summary of what was done and what was found

Brief, structured, appropriate keywords

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STROBE check list

Item Introduction Comments

Background/ rationale 2. Explain the scientific background and

rationale for the study being reported-Facts? - Novelty from previous studies?

Objectives 3. State specific objectives, including any pre-specified hypotheses Specific

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METHODS: Setting:

• Chennai: Census, Cross-sectional surveys were conducted in the catchment area and

clinic study at the Besant Nagar clinic City, Coastal, Tropical wet & dry climate-, Malaria perennial P. vivax common; The Main malaria Vector- An. stephensi

• Nadiad : Town, Sub-tropical and semi-arid climate; Malaria hypo-endemic. Census and Cross-sectional surveys, was conducted in the residential areas

around the NIMR malaria clinic and in Sevaliya and Chetarsumba. Clinic study at NIMR clinic, Civil Hospital, Nadiad town. P. vivax and P. falciparum oscillating throughout the year. The main malaria vector is An. Culicifacies.

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METHODS: Setting: Contd…..

• Rourkela Census was conducted in the areas around Sector 1 Health Centre (Malaria

clinic-near slum areas) and the rural forested areas of Sundargarh district. Rural, Tropical wet & dry climate, Malaria Meso-Hyperendemic P. falciparum common; The Main malaria Vector- An. Culicifacies & An.

Fluviatilis

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METHODS:

Procedure: Census from households near the clinics Four cross-sectional surveys were conducted over two years, each drawing

subjects from a different random selection of census household members. Patients visiting the malaria clinics at the three sites with symptoms

indicative of malaria were enrolled in the clinic-based study (not linked to census data)

•They were subjected to a structured questionnaire with sections on malaria history and use of

mosquito protection- ALL blood tests for microscopy (Smear for malarial parasite) and hemoglobin

assessment- CROSS-SECTIONAL & CLINIC STUDY ALONE Questions on type of housing, water supply, use of malaria protection and

demographics of the household members (age, gender, education and occupation)- CENSUS ALONE

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METHODS:

Laboratory methods:•Laboratory tests were performed for all individuals enrolled in the cross-sectional surveys and clinic studies.

•Hemoglobin level was assessed at the time of enrollment using HemoCue (HemoCue, Ängelholm, Sweden).

•Thin and thick smears obtained from blood collected via a finger prick.

•They were stained using Giemsa and at least 300 fields in the thick smear were examined using the 100× oil immersion before a slide was determined negative for malaria.

•The results were expressed as parasites per microliter of blood

•Slides were routinely read by two microscopists and a third was used if there was disagreement.

•In addition, 10 % of the slides were re-checked for quality control.

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METHODS:

Analysis:•Web based REDCap (Research Electronic Data Capture) database was used to capture and store all participant data and test results.

•Data were exported into Stata (Stata/IC version 13.1, StataCorp LP, College Station, USA) for analysis.

•Only households and individuals with information available on repellents were included in the analysis

• Principle components analysis was used to construct a wealth index to assess effect of SES.

•Determinants of overall use of repellents and the two most common types used in a region were examined.

•Factors and their association with the use of repellents at each levels were evaluated separate for each levels .

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METHODS:

Analysis: Contd…•In the survey and clinic data the association between the use of repellent and malaria, and of repellent and anemia were explored

•Generalized linear regression with a log link and binomial distribution was used for multivariate analyses.

•Poisson regression with a robust variance estimator was used for models which did not converge .

•Factors with a P-value < 0.1 in the univariate model were included in the multivariate model, and factors with a P-value > 0.05 were removed from the model, except for factors of special interest.

•The multivariate model for surveys was adjusted for clustering at the household level.

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STROBE check list

Item Methods Comments

Study design 4. Present key elements of study design

early in the paperThree sites of data collection mentioned,Census ?

Setting 5. Describe the setting, locations and relevant dates, including periods of recruitment and data collection

Time period not specified for each site

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STROBE check list

Item Methods Comments

Participants6. Give the eligibility criteria, and the sources and methods of selection of participants Mentioned

Variables7. Clearly define all outcomes, exposures, predictors, potential confounders and effect modifiers. Give diagnostic criteria, if applicable

Variables at each level, Lab tests

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STROBE check list

Item Methods Comments

Data sources/measurement

8. For each variable of interest, give sources of data and details of methods ofassessment (measurement). Describe comparability of assessment methods if there is more than one group

Bias 9. Describe any efforts to address potential sources of bias

No information on the potential source of bias - Endemicity

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STROBE check list

Item Methods Comments

Sample size 10. Explain how the study size was arrived at

No mention about sample size estimation in cross sectional surveys

Quantitative Variables

11. Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why

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STROBE check list

Item Methods Comments

Statistical methods

12(a) Describe all statistical methods, including those used to control for confounding(c) Explain how missing data were addressed(d) If applicable, describe analytical methods taking account of sampling strategy(e) Describe any sensitivity analyses

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RESULTS :

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STROBE check listItem Results Comments

Participants13(a) Report the numbers of individuals at each stage of the study(b) Give reasons for non-participation at each stage(c) Consider use of a flow diagram

No reasons for non participation

Descriptive data

14(a) Give characteristics of study participants (e.g. demographic, clinical, social) and information on exposures and potential confounders(b) Indicate the number of participants with missing data for each variable of interest

Has not compared the characteristic between groups

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STROBE check listItem Results Comments

Main results

16(a) Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (e.g. 95% confidence interval). Make clear which confounders were adjusted for and why they were included(b) Report category boundaries when continuous variables were categorized

Confidence Intervals for certain data could have been provided

Other Analyses17. Report other analyses done – e.g. analyses of subgroups and interactions, and sensitivity analyses

Tables instead of graphs

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DISCUSSION:•The reported use of repellents was generally more common at the household level during the census than at the individual level in the surveys.

•The higher prevalence of repellents in Chennai and Nadiad could be due to urban areas being more exposed to health messages- higher SES & Education.

•Vaporizers more in Chennai, Coils most preferable in Nadiad & Rourkela.

•Use of creams was overall low.

•The use of ITNs was low except for Rourkela.

•Households with young children were more likely to use repellents in Chennai and Nadiad. This was not the case in the household surveys in Raurkela.

•In the clinic studies in Nadiad and Raurkela, a higher use of vaporizers among children < 5 years of age was noted.

•Although in Nadiad and Chennai, households with young boys appeared more likely than households with young girls to use vaporizers.

•The use of repellents is usually greater when the burden of mosquitoes increases.

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LIMITATIONS:• No information on the brand and the cost.

• Did not verify the use of the repellent and assure the type it belongs

• Lacked Quantification of use.

• Did not Confirm the proper use/ possession of nets.

• No mention on the efficacy of Repellents (census & survey).

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CONCLUSIONS:• There is considerable repellent use in India, with a wide variety of products available.

•Their use is mainly determined by socio-economic status and level of education.

•An attractive option to reduce mosquito bites during day time, and the early evening.

•Needs further clinical testing of these methods and evaluation of safety will be useful for an evidence-based recommendation.

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STROBE check list

Item Discussion Comments

Key Results 18.Summarize key results with reference to study objectives Mentioned

Limitations19.Discuss limitations of the study, taking into account sources of potential bias or imprecision. Discuss both direction and magnitude of any potential bias

Mentioned

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STROBE check listItem Discussion Comments

Interpretation

20.Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence

More emphasis on Relevant Evidence

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FUNDING: Research reported in this publication was supported by the National Institute of Allergy And Infectious Diseases of the National Institutes of Health under Award Number as part of the International Centers for Excellence in Malaria Research

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STROBE check list

Item Discussion

Funding22. Give the source of funding and the role of the funders for the present study and, if applicable, for the original study on which the present article is based

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Thank You…