A Qualitative Assessment of the Community Perceptions of Indoor Residual Spraying (IRS) as a malaria prevention mechanism in Mwanza, Tanzania Open Access

Frimpong, Phyllis (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/7s75dd06f?locale=en
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Abstract

Abstract

Background: The WHO estimated that in 2010, 219 million clinical cases of malaria occurred with an associated death toll of 627, 000 worldwide. Currently in Tanzania, malaria causes 60,000- 80,000 death annually, mainly in children and pregnant women. The successful elimination of malaria transmission in Tanzania is critical for the reduction of child and maternal mortality and reduction of strain on health facilities. To reduce malaria disease burden, the President's Malaria Initiative (PMI) implemented Indoor Residual Spraying (IRS) in Tanzania as a control strategy.

Objective: The main objective of this study was to examine perceptions about IRS as a malaria control mechanism for one particular district in Tanzania. Reasons for IRS refusal and acceptance and suggestions for improving IRS in the district were explored.

Methods: Qualitative methods were used to explore IRS perceptions, popular malaria prevention methods, issues stifling efficiency of IRS and suggestions for IRS improvement. Four focus group discussions and sixteen illness narrative interviews were conducted. All discussions and interviews were digitally recorded and, transcribed in Kiswahili and translated into English. Data was analyzed using Nvivo8.

Results: Participants were knowledgeable about the general causes of malaria. Two broad categories of people were identified: individuals whose homes had been sprayed and others whose homes had not been sprayed. Overall most homes had been sprayed but perceptions about IRS were mainly negative. This was due to inadequate community sensitization about IRS, increased prevalence of bed bugs and other insects, rumors, logistical hurdles and an unabated malaria and mosquitoes prevalence.

Discussion: To increase IRS acceptance and effectiveness, timely and detail-oriented community sensitization for subsequent IRS activities is stressed. Broader measures for malaria reduction in the environment and measures to counteract the rampant insect infestation following IRS are necessary. Improvement of sprayers utility in assisting women especially with the logistical hurdles is emphasized. Addressing the negative perceptions about IRS will improve communal experiences with IRS and enhance its delivery.

Keywords: Malaria, Indoor Residual Spraying (IRS), Mosquito, Malaria prevention, Community sensitization

Table of Contents

TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION..................................................................... 1

CHAPTER 2: LITERATURE REVIEW.............................................................. 4

Background................................................................................................. 4

Statement of Objectives.................................................................................. 5

Malaria in Tanzania....................................................................................... 6

President's Malaria Initiative (PMI)................................................................... 8

PMI in Tanzania........................................................................................... 9

Malaria Control Strategies in Tanzania.............................................................. 10

Insecticide Treated Nets (ITN)............................................................................................. 10

Case Management with Artemisinin-Based Therapy (ACTs)............................................. 11

Intermittent Preventive Treatment in Pregnancy (IPTp)..................................................... 11

IRS in the Lake Zone.................................................................................... 12

Relevant studies on IRS community perspectives................................................... 13

IRS Knowledge Gap..................................................................................... 16

CHAPTER 3. MANUSCRIPT........................................................................ 18

Title Page................................................................................................... 18

Contribution of Student................................................................................. 18

1. INTRODUCTION.................................................................................. 20

2. METHODS............................................................................................ 22

Study design......................................................................................................................... 23

Site Selection......................................................................................................................... 23

Data Collection Methods and Participant Recruitment....................................................... 24

3. RESULTS.............................................................................................. 29

Perception of Malaria Burden.............................................................................................. 29

Overall Causes of Malaria................................................................................................... 30

Preferred Malaria Prevention Methods............................................................................... 31

General Knowledge about IRS and perceptions of effectiveness...................................... 34

Negative Results and Perceptions about IRS....................................................................... 39

Minimal Reduction in Malaria burden and Mosquitoes population.................................. 42

Insecticide mixing procedure and application issues....................................................... 43

Logistical constraints............................................................................................................ 44

Privacy related issues.......................................................................................................... 45

Reported Side effects........................................................................................................... 46

Rumors.................................................................................................................................. 47

Positive Perceptions about IRS............................................................................................. 48

Community sensitization on IRS........................................................................................... 50

Community members' Recommendations......................................................................... 55

4. DISCUSSION......................................................................................... 57

Examining perceptions about community sensitization prior to IRS activities................. 57

What the community considers "adequate" information................................................... 58

When the community considers information provided to be "timely"............................. 59

Who is the appropriate person to facilitate community sensitization?.............................. 60

Means of information delivery is suitable for the community............................................ 61

Exploring reactions to logistics of IRS................................................................................. 62

Exploring perceived benefits of spraying to the community............................................ 63

RECOMMENDATIONS............................................................................... 66

STUDY LIMITATIONS................................................................................ 69

CONCLUSION........................................................................................... 69

CHAPTER 4. RECOMMENDATIONS AND CONCLUSIONS............................ 71

PUBLIC HEALTH IMPLICATIONS................................................................ 71

RECOMMENDATIONS............................................................................... 72

STUDY LIMITATIONS................................................................................ 75

CONCLUSION........................................................................................... 75

REFERENCES............................................................................................ 77

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