Background: Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use. Methods: Community forums and a household, cross-sectional survey were used to collect information on factors related to bed net ownership and use in western Kenya. Sites with disparate levels of transmission were selected, including an endemic lowland area, Miwani, and a highland epidemic-prone area, Kapkangani. Analysis of ownership was stratified by site. A combined site analysis was conducted to examine factors associated with use of all available bed nets. Logistic regression modelling was used to determine factors associated with ownership and use of owned bed nets. Results: Access to bed nets as the leading barrier to their use was identified in community forums and cross-sectional surveys. While disuse of available bed nets was discussed in the forums, it was a relatively rare occurrence in both sites. Factors associated with ownership varied by site. Education, perceived risk of malaria and knowledge of individuals who had died of malaria were associated with higher bed net ownership in the highlands, while in the lowlands individuals reporting it was easy to get a bed net were more likely to own one. A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria. In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season. Conclusion: Variations in factors associated with ownership should be acknowledged when constructing messaging and distribution campaigns. Despite reports of bed nets being used for other purposes, those in the home were rarely unused in these communities. Disuse seemed to be related to beliefs that can be addressed through education programmes. As mass distributions continue to take place, additional research is needed to determine if factors associated with LLIN ownership and use change with increasing availability of LLIN.

Background: Despite progress made in the last decades, malaria persists as a pressing health issue in sub-Saharan Africa. Pregnant women are particularly vulnerable to infection and serious health outcomes for themselves and their unborn child. Risk can be mitigated through appropriate use of control measures such as insecticide-treated bed nets. Although social networks can influence uptake of preventive strategies, the role of social influence on bed net ownership has not been explored. During an evaluation of a bed net distribution programme, the influence of non-health care advisors on ownership and use of bed nets by pregnant women in Kumasi, Ghana was examined. Methods: Data were collected through in-person interviews with 300 pregnant women seeking antenatal care in an urban hospital in Kumasi, Ghana. Participants were asked about their bed net ownership, bed net use, and information about three personal contacts that they go to for pregnancy advice. Information about these advisors was combined into an influence score. Logistic regression models were used to determine the association between the score and bed net ownership. Those who owned a bed net were further assessed to determine if interpersonal influence was associated with self-reported sleeping under the bed net the previous night. Results: Of the 294 women in the analysis, 229 (78%) reported owning bed nets. Of these bed net owners, 139 (61%) reported using a bed net the previous night. A dose response relationship was observed between the interpersonal influence score and bed net ownership and use. Compared to the lowest influence score, those with the highest influence score (> 1 SD above the mean) were marginally more likely to own a bed net [OR = 2.37, 95% CI (0.87, 6.39)] and much more likely to use their bed net [5.38, 95% CI (1.89, 15.25)] after adjusting for other factors. Conclusions: Interpersonal influence appears to have modest impact on ownership and use of bed nets by pregnant women in an urban area of Ghana. Further investigations would need to be conducted to determine if the relationship is causal or if individuals who associate are simply more likely to have similar practices.

Malaria is caused by Plasmodium parasites, which are transmitted via the bite of infected female anopheles mosquitoes. There were 217 million cases of malaria worldwide, and about 435,000 malaria related deaths in 2017. WHO Africa region accounted for 92% and 93% of malaria cases and deaths worldwide. According to The Gambia National Malaria Strategic Plan 2013-2020, malaria is a leading cause of morbidity and mortality. The aim of this study was to identify factors influencing attitude towards the use of mosquito nets in households in The Gambia using Demographic and Health Survey (DHS) data. The current study is a secondary data analysis with a, cross-sectional study design. The source of the data for this study is the DHS, which was conducted by the United States Agency for International Development (USAID) together with the Gambia Bureau of Statistics (GBOS) in 2013. The study sample is representative of The Gambian population. The sample size for the study was 5276 subjects. Statistical Analysis System (SAS 9.3) was used for data analysis. Descriptive statistics were generated for the factors been tested. These included area of residence, presence of electricity, indoor residual spraying, highest level of education and wealth index. The outcome variable measured was household use of mosquito nets (Yes/No). Logistic regression analysis was done to determine whether area of residence, wealth index, education level, presence of electricity and indoor residual spraying influence attitude towards use of mosquito nets in households. Stepwise binary logistic regression was used to determine the final model with the most significant predictors. Odds ratios and corresponding confidence intervals were reported. Most of the study participants were poor (46%). Those with no education made up 45.5% of the study population and 58% of dwellings had no indoor residual spraying done in the past year. 76.6% and 59.1% of respondents lived in households that had at least one mosquito net and no electricity supply, respectively. 50.6% of the respondents resided in rural areas. Logistic regression analysis showed that wealth index, indoor residual spraying and area of residence were significant factors (p<0.05) influencing attitude towards use of mosquito nets in households. Indoor residual spraying (OR=2.00; 95% C.I. 1.71-2.36), primary school education (OR=1.1; 95% C.I. 0.94-1.32), middle class wealth index (OR=1.32; 95% C.I. 1.05-1.67) and rural residence (OR=1.29; 95% C.I. 1.01-1.64) are all independent factors that increased likelihood of mosquito net usage in households. Identifying factors that influence the usage of mosquito nets in households, can be useful in developing target interventions to further reduce malaria morbidity and mortality in The Gambia. Knowledge from this study can be used to further strengthen the national malaria strategic plan. To further establish causality and increase strength of association between factors and outcome, a case control or cohort study design will be needed, since that is one of the limitations of a cross sectional study.

In highly competitive industries where firms aren’t protected by barriers to entry and consumers’ preferences are constantly changing, the willingness and ability to adapt and continually improve operations may be critical for continued success. However, the internal exchanges between employees and managers that may be an integral part of the development and implementation of new ideas are often not modeled or included in our standard economic theories. In this research I investigate whether a higher level of employee voice (or employee input) predicts higher levels of continual improvement, and whether this continual improvement predicts higher levels of firm performance. Additionally, I will study whether humble managers keep this process going by fostering an environment where employees feel free to provide input. If this chain of events can help us better understand differences in firm performance then perhaps we can enhance our models by measuring and including these internal firm characteristics instead of simply leaving them inside the error term and calling them “unobservable.” Results across three separate studies show that humble managers are more likely to be perceived as making continual improvements and higher levels of perceived continual improvement leads to both greater levels of employee voice and fewer perceived job obstacles. A pilot study involving two separate quick-food restaurant chains also lends support for the above ideas, but uses sales in dollars as the measure for performance. Additionally, holding the employee constant in a fixed-effects analysis shows that the same employee is more likely to voice ideas to a manager he or she reports as continually improving the way things are done.

[pt] Em 2015 quase metade da população mundial vivia em área de risco de transmissão de malária. Neste mesmo ano, estimam-se 214 milhões de casos e 438 mil fatalidades. A principal forma de prevenção e redução da transmissão da malária é através do controle dos vetores, em particular, destaca-se o uso de mosquiteiros impregnados com inseticidas de longa duração (MILD). Neste contexto, os programas de distribuição de MILDS enfrentam desafios relacionados a obtenção de fundos e à gestão da cadeia de suprimentos como, por exemplo, incertezas associadas as atividades logísticas, as variáveis de oferta e demanda, e a volatilidade de preços. À luz destes fatos, esta dissertação propõe um modelo de otimização robusta, fundamentado em extensões dos arcabouços teóricos de Bertsimas e Sim (2004) e Fernandes et al. (2016), capaz de minimizar os custos de um programa de distribuição de mosquiteiros ou, dada uma restrição orçamentária, maximizar a distribuição para áreas prioritárias. Ademais, foi realizada uma revisão da literatura acadêmica acerca de modelos de otimização robusta aplicados no contexto da logística humanitária, onde alguns aspectos ainda pouco explorados foram ressaltados e considerados no modelo proposto. Um estudo de caso real é feito sobre um projeto feito do Fundo das Nações Unidas para crianças na Costa do Marfim. Os resultados apontam que conforme esperado, à medida que o nível de robustez considerado no modelo cresce, os custos totais também aumentam. Em contrapartida, o modelo robusto fornece soluções com maior flexibilidade na cadeia de suprimentos para a eventual necessidade de se ajustar os planos de compras e distribuição. Por fim, as soluções robustas foram avaliadas através de simulações de Monte Carlo, indicando que, conforme desejado, a probabilidade de viabilidade dos planos aumentam junto com nível de conservadorismo da solução. / [en] In 2015, almost half of the world population lived in areas at risk of malaria transmission. There were around 214 million malaria cases and 438,000 associated deaths. One of the major paths to prevent and reduce malaria transmission is through vector control, especially with the use of insecticide-treated nets (ITN). In this context, ITN distribution campaigns face several challenges, such as uncertainties related to funding, transportation, market and price volatility, which might be effectively tackled through long-term agreements and proper planning. However, that might not be an option for all humanitarian organizations and governments. Besides, considering uncertainties during budgetary planning is particular relevant. In this sense, a robust optimization model, based on Bertsimas and Sim (2004) and Fernandes et al. (2016) frameworks, is proposed to minimize the involved costs or, given a budget constraint, maximize the coverage of priority areas. A literature review on robust optimization applied to humanitarian logistics is conducted, in which aspects with less academic research attention are revealed and considered in the model, such as the simultaneous account of the aforementioned uncertainties and demand prioritization. A United Nations Children s Fund campaign in Ivory Coast is studied, and reveals that, as expected, as the robustness level increases so does the total costs. In return, the robust model generally provides a solution with improved supply chain flexibility, that might minimize efforts, in case it is necessary to adjust procurement and transportation plans when uncertainty is revealed. In addition, robust solutions were assessed through Monte Carlo simulations against several realizations of uncertain parameters values, pointing that, as desired, solution feasibility increases alongside the specified level of conservatism.